Provider Demographics
NPI:1710466578
Name:EVANS, JUSTINE M (RN)
Entity Type:Individual
Prefix:
First Name:JUSTINE
Middle Name:M
Last Name:EVANS
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 1:351 SUGARLOAF TRL APT 5213
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75069-7511
Mailing Address - Country:US
Mailing Address - Phone:972-400-3538
Mailing Address - Fax:
Practice Address - Street 1:351 SUGARLOAF TRL APT 5213
Practice Address - Street 2:
Practice Address - City:FAIRVIEW
Practice Address - State:TX
Practice Address - Zip Code:75069-7511
Practice Address - Country:US
Practice Address - Phone:972-400-3538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-11
Last Update Date:2018-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX938912163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse