Provider Demographics
NPI:1497961122
Name:USSIN, EVANGELINA JOHNSON (MSW,RSW)
Entity Type:Individual
Prefix:MS
First Name:EVANGELINA
Middle Name:JOHNSON
Last Name:USSIN
Suffix:
Gender:F
Credentials:MSW,RSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1377 GAUSE BLVD W
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70460-5765
Mailing Address - Country:US
Mailing Address - Phone:985-847-9485
Mailing Address - Fax:866-200-0061
Practice Address - Street 1:1377 GAUSE BLVD W
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70460-5765
Practice Address - Country:US
Practice Address - Phone:985-847-9485
Practice Address - Fax:866-200-0061
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA251E00000X251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1370924Medicaid
LA1641481Medicaid
LA1758451Medicaid
LA1356921Medicaid
LA1641928Medicaid