Provider Demographics
NPI:1417341512
Name:EVANS, ROSE (CRNFA)
Entity Type:Individual
Prefix:MRS
First Name:ROSE
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:CRNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 PINECREST DR
Mailing Address - Street 2:
Mailing Address - City:MCCOMB
Mailing Address - State:MS
Mailing Address - Zip Code:39648-8285
Mailing Address - Country:US
Mailing Address - Phone:601-249-5500
Mailing Address - Fax:601-249-1853
Practice Address - Street 1:1011 PINECREST DR
Practice Address - Street 2:
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648-8285
Practice Address - Country:US
Practice Address - Phone:601-249-5500
Practice Address - Fax:601-249-1853
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-26
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR850860163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical