Provider Demographics
NPI:1275954307
Name:EVANS, CAROL DENISE (RN)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:DENISE
Last Name:EVANS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:DENISE
Other - Last Name:GARDNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1 CEDAR FARMS DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-3624
Mailing Address - Country:US
Mailing Address - Phone:302-438-7067
Mailing Address - Fax:
Practice Address - Street 1:1 CEDAR FARMS DR
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-3624
Practice Address - Country:US
Practice Address - Phone:302-438-7067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-16
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL1-0024417163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE$$$$$$$$$Medicare PIN