Provider Demographics
NPI:1063027662
Name:BATTEN, EVON MARIE
Entity Type:Individual
Prefix:
First Name:EVON
Middle Name:MARIE
Last Name:BATTEN
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 1:1102 WOLF RUN RD
Mailing Address - Street 2:
Mailing Address - City:ORMA
Mailing Address - State:WV
Mailing Address - Zip Code:25268-8736
Mailing Address - Country:US
Mailing Address - Phone:304-377-4841
Mailing Address - Fax:
Practice Address - Street 1:1102 WOLF RUN RD
Practice Address - Street 2:
Practice Address - City:ORMA
Practice Address - State:WV
Practice Address - Zip Code:25268-8736
Practice Address - Country:US
Practice Address - Phone:304-377-4841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant