Provider Demographics
NPI:1497983415
Name:EVANS, CONI LEE (RN)
Entity Type:Individual
Prefix:MS
First Name:CONI
Middle Name:LEE
Last Name:EVANS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:CONI
Other - Middle Name:
Other - Last Name:NELSON EVANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:4375 FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-6523
Mailing Address - Country:US
Mailing Address - Phone:775-853-1060
Mailing Address - Fax:775-853-1060
Practice Address - Street 1:745 W MOANA LN
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-4991
Practice Address - Country:US
Practice Address - Phone:775-334-3033
Practice Address - Fax:775-334-3022
Is Sole Proprietor?:No
Enumeration Date:2009-06-29
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRN14812163W00000X, 163WP0809X, 163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
No163W00000XNursing Service ProvidersRegistered Nurse
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant