Provider Demographics
NPI:1164778262
Name:EVANS, BETH ANN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:BETH
Middle Name:ANN
Last Name:EVANS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:ANN
Other - Last Name:HAYSLIP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:63 COLEMAN RD UNIT C
Mailing Address - Street 2:
Mailing Address - City:WEST PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45663-3035
Mailing Address - Country:US
Mailing Address - Phone:740-858-2018
Mailing Address - Fax:
Practice Address - Street 1:63 COLEMAN RD UNIT C
Practice Address - Street 2:
Practice Address - City:WEST PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45663-3035
Practice Address - Country:US
Practice Address - Phone:740-858-2018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-26
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH140957164W00000X
KY2046569164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse