Provider Demographics
NPI:1508473224
Name:EVANS, SONYA MARIE
Entity Type:Individual
Prefix:
First Name:SONYA
Middle Name:MARIE
Last Name:EVANS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 ASHLEY CT
Mailing Address - Street 2:
Mailing Address - City:SHANKS
Mailing Address - State:WV
Mailing Address - Zip Code:26761-1404
Mailing Address - Country:US
Mailing Address - Phone:304-822-0794
Mailing Address - Fax:
Practice Address - Street 1:202 ASHLEY CT
Practice Address - Street 2:
Practice Address - City:SHANKS
Practice Address - State:WV
Practice Address - Zip Code:26761-1404
Practice Address - Country:US
Practice Address - Phone:304-822-0794
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-27
Last Update Date:2020-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant