Provider Demographics
NPI:1346017738
Name:EVANS, DEMETRICE (CNA)
Entity Type:Individual
Prefix:MS
First Name:DEMETRICE
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3235 COLUMBIA HWY S
Mailing Address - Street 2:
Mailing Address - City:ESTILL
Mailing Address - State:SC
Mailing Address - Zip Code:29918-6221
Mailing Address - Country:US
Mailing Address - Phone:912-334-9914
Mailing Address - Fax:
Practice Address - Street 1:3235 COLUMBIA HWY S
Practice Address - Street 2:
Practice Address - City:ESTILL
Practice Address - State:SC
Practice Address - Zip Code:29918-6221
Practice Address - Country:US
Practice Address - Phone:912-334-9914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-06
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC161222374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide