Provider Demographics
NPI:1114680097
Name:EVANS, SANDRA RENAE (FNP-BC, FNP-C)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:RENAE
Last Name:EVANS
Suffix:
Gender:F
Credentials:FNP-BC, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2228 LAWRENCE ST W
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35653-5116
Mailing Address - Country:US
Mailing Address - Phone:256-668-5216
Mailing Address - Fax:
Practice Address - Street 1:2228 LAWRENCE ST W
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AL
Practice Address - Zip Code:35653-5116
Practice Address - Country:US
Practice Address - Phone:256-668-5216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-18
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-069598363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care