Provider Demographics
NPI:1225628035
Name:EVANS, AMANDA JEAN
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:JEAN
Last Name:EVANS
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 1:5704 KENTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SCIOTOVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45662-5469
Mailing Address - Country:US
Mailing Address - Phone:740-776-7086
Mailing Address - Fax:
Practice Address - Street 1:3900 RHODES AVE APT 207
Practice Address - Street 2:
Practice Address - City:NEW BOSTON
Practice Address - State:OH
Practice Address - Zip Code:45662-4956
Practice Address - Country:US
Practice Address - Phone:740-456-0830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-25
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH231465427Medicaid