Provider Demographics
NPI:1548758212
Name:YEAUGER, EVAN (LPN)
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:
Last Name:YEAUGER
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:POINT PLEASANT
Mailing Address - State:WV
Mailing Address - Zip Code:25550-3985
Mailing Address - Country:US
Mailing Address - Phone:740-416-4561
Mailing Address - Fax:
Practice Address - Street 1:49 RIDGE RD
Practice Address - Street 2:
Practice Address - City:POINT PLEASANT
Practice Address - State:WV
Practice Address - Zip Code:25550-3985
Practice Address - Country:US
Practice Address - Phone:740-416-4561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-27
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH168037164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse