Provider Demographics
NPI:1417363300
Name:EVANS, SYLVIA JADE (STNA)
Entity Type:Individual
Prefix:
First Name:SYLVIA
Middle Name:JADE
Last Name:EVANS
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 KERNS DR NE
Mailing Address - Street 2:APT B
Mailing Address - City:BOLIVAR
Mailing Address - State:OH
Mailing Address - Zip Code:44612-8201
Mailing Address - Country:US
Mailing Address - Phone:330-936-0532
Mailing Address - Fax:
Practice Address - Street 1:801 KERNS DR NE
Practice Address - Street 2:APT B
Practice Address - City:BOLIVAR
Practice Address - State:OH
Practice Address - Zip Code:44612-8201
Practice Address - Country:US
Practice Address - Phone:330-936-0532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-11
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401437360912376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide