Provider Demographics
NPI:1336103498
Name:EVANS, JANET ETCHISON (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:JANET
Middle Name:ETCHISON
Last Name:EVANS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:JANET
Other - Middle Name:MARIE
Other - Last Name:ETCHISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:8280 NAUTICAL POINT DRIVE
Mailing Address - Street 2:
Mailing Address - City:BELEWS CREEK
Mailing Address - State:NC
Mailing Address - Zip Code:27009
Mailing Address - Country:US
Mailing Address - Phone:336-595-2699
Mailing Address - Fax:336-832-1917
Practice Address - Street 1:501 NORTH ELAM AVE
Practice Address - Street 2:WESLEY LONG HOSPITAL
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27403
Practice Address - Country:US
Practice Address - Phone:336-832-1818
Practice Address - Fax:336-832-1917
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN571928367500000X
NC108080163W00000X
NC042216367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8051079Medicaid
PA042216OtherAANA NO.
NC2625874DMedicare PIN
NC2625874AEMedicare PIN
NC8051079Medicaid