Provider Demographics
NPI:1639876840
Name:EVANS, JEANENE (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:JEANENE
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 NIEDHAWK LN
Mailing Address - Street 2:
Mailing Address - City:MOHNTON
Mailing Address - State:PA
Mailing Address - Zip Code:19540-7782
Mailing Address - Country:US
Mailing Address - Phone:215-380-5825
Mailing Address - Fax:
Practice Address - Street 1:55 NIEDHAWK LN
Practice Address - Street 2:
Practice Address - City:MOHNTON
Practice Address - State:PA
Practice Address - Zip Code:19540-7782
Practice Address - Country:US
Practice Address - Phone:215-380-5825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-08
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAL-309919163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant