Provider Demographics
NPI:1649740010
Name:EVANS, CONNIE S
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:S
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 1:4418 W WENDOVER AVE
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-2600
Mailing Address - Country:US
Mailing Address - Phone:336-851-5561
Mailing Address - Fax:336-272-9069
Practice Address - Street 1:100 E NORTHWOOD ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1310
Practice Address - Country:US
Practice Address - Phone:336-908-2690
Practice Address - Fax:336-272-9069
Is Sole Proprietor?:No
Enumeration Date:2018-11-28
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1567237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist