Provider Demographics
NPI:1346842994
Name:EVANICH, BILLIE JEAN
Entity Type:Individual
Prefix:
First Name:BILLIE
Middle Name:JEAN
Last Name:EVANICH
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 1:208 CHESHIRE WAY STE 1
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25704-2064
Mailing Address - Country:US
Mailing Address - Phone:304-429-0100
Mailing Address - Fax:
Practice Address - Street 1:208 CHESHIRE WAY STE 1
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25704-2064
Practice Address - Country:US
Practice Address - Phone:304-429-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator