Provider Demographics
NPI:1043761984
Name:BLEVINS, EVETTE LEMILLE
Entity Type:Individual
Prefix:
First Name:EVETTE
Middle Name:LEMILLE
Last Name:BLEVINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:EVETTE
Other - Middle Name:LEMILLE
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNA
Mailing Address - Street 1:101 PIGEONHOUSE CT
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-0244
Mailing Address - Country:US
Mailing Address - Phone:910-496-6896
Mailing Address - Fax:
Practice Address - Street 1:101 PIGEONHOUSE CT
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28311-0244
Practice Address - Country:US
Practice Address - Phone:910-496-6896
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-15
Last Update Date:2016-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No376K00000XNursing Service Related ProvidersNurse's Aide