Provider Demographics
NPI:1619859055
Name:EVANS, MONICA CHANTEL
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:CHANTEL
Last Name:EVANS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 S 24TH ST APT 109
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68108-1868
Mailing Address - Country:US
Mailing Address - Phone:531-352-0142
Mailing Address - Fax:531-352-0142
Practice Address - Street 1:3101 S 24TH ST APT 109
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68108-1868
Practice Address - Country:US
Practice Address - Phone:531-352-0142
Practice Address - Fax:531-352-0142
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-25
Last Update Date:2025-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child