Provider Demographics
NPI:1699416289
Name:PEREA, EVELYN JOY
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:JOY
Last Name:PEREA
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 1:53 MAPLE ALY
Mailing Address - Street 2:
Mailing Address - City:TERRA ALTA
Mailing Address - State:WV
Mailing Address - Zip Code:26764-6317
Mailing Address - Country:US
Mailing Address - Phone:304-594-6633
Mailing Address - Fax:
Practice Address - Street 1:53 MAPLE ALY
Practice Address - Street 2:
Practice Address - City:TERRA ALTA
Practice Address - State:WV
Practice Address - Zip Code:26764-6317
Practice Address - Country:US
Practice Address - Phone:304-594-6633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-06
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant