Provider Demographics
NPI:1134924095
Name:EVANS, CAROLYN DIANE (RN)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:DIANE
Last Name:EVANS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19400 E 37TH TERRACE CT S APT 807
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64057-2489
Mailing Address - Country:US
Mailing Address - Phone:816-810-7597
Mailing Address - Fax:
Practice Address - Street 1:19400 E 37TH TERRACE CT S APT 807
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64057-2489
Practice Address - Country:US
Practice Address - Phone:816-810-7597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-14
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006007363163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice