Provider Demographics
NPI:1558624924
Name:MARCIEL, EVELYN L (RN)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:L
Last Name:MARCIEL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14215 ROAD 28
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93638-5729
Mailing Address - Country:US
Mailing Address - Phone:559-675-7893
Mailing Address - Fax:
Practice Address - Street 1:14215 ROAD 28
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93638-5729
Practice Address - Country:US
Practice Address - Phone:559-675-7893
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-20
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA288822163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health