Provider Demographics
NPI:1417625104
Name:EVANS, LIZA CORINNE
Entity Type:Individual
Prefix:MRS
First Name:LIZA
Middle Name:CORINNE
Last Name:EVANS
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:LIZA
Other - Middle Name:CORINNE
Other - Last Name:BLOOMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:804 3RD ST
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:OH
Mailing Address - Zip Code:45067-1918
Mailing Address - Country:US
Mailing Address - Phone:513-320-5753
Mailing Address - Fax:
Practice Address - Street 1:COMMUNITY CORRECTIONS CENTER
Practice Address - Street 2:5234 STATE ROUTE 63
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036
Practice Address - Country:US
Practice Address - Phone:513-933-9304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator