Provider Demographics
NPI:1538373550
Name:EVANS, JOAN ELLEN (HOME CARE PROVIDER)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:ELLEN
Last Name:EVANS
Suffix:
Gender:F
Credentials:HOME CARE PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3757 WEEPING WILLOW BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43207-3467
Mailing Address - Country:US
Mailing Address - Phone:614-491-8525
Mailing Address - Fax:
Practice Address - Street 1:1703 CREEK RD
Practice Address - Street 2:
Practice Address - City:SUNBURY
Practice Address - State:OH
Practice Address - Zip Code:43074-8379
Practice Address - Country:US
Practice Address - Phone:740-965-8892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHM2512516171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications