Provider Demographics
NPI:1114434024
Name:SADLER, EVELYN SUE (PCA)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:SUE
Last Name:SADLER
Suffix:
Gender:F
Credentials:PCA
Other - Prefix:
Other - First Name:EVELYN
Other - Middle Name:SUE
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:102 HERITAGE ROAD
Mailing Address - Street 2:
Mailing Address - City:YAWKEY
Mailing Address - State:WV
Mailing Address - Zip Code:25573
Mailing Address - Country:US
Mailing Address - Phone:304-356-4562
Mailing Address - Fax:304-558-4563
Practice Address - Street 1:102 HERITAGE ROAD
Practice Address - Street 2:
Practice Address - City:YAWKEY
Practice Address - State:WV
Practice Address - Zip Code:25573
Practice Address - Country:US
Practice Address - Phone:304-524-7227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-02
Last Update Date:2018-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810009159OtherPROVIDER ID