Provider Demographics
NPI:1568785251
Name:HARRELL, EVELLA DENEAN (LPN)
Entity Type:Individual
Prefix:MS
First Name:EVELLA DENEAN
Middle Name:
Last Name:HARRELL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 CHEMUNG ST
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:NY
Mailing Address - Zip Code:14830-3244
Mailing Address - Country:US
Mailing Address - Phone:845-418-9550
Mailing Address - Fax:
Practice Address - Street 1:199 CHEMUNG ST
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:NY
Practice Address - Zip Code:14830-3244
Practice Address - Country:US
Practice Address - Phone:845-418-9550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-09
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY256801-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse