Provider Demographics
NPI:1780038984
Name:JIMENEZ, EVELYN
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:
Last Name:JIMENEZ
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:P.O. BOX 190
Mailing Address - Street 2:
Mailing Address - City:ST. STEPHENS
Mailing Address - State:WY
Mailing Address - Zip Code:82524
Mailing Address - Country:US
Mailing Address - Phone:307-856-0470
Mailing Address - Fax:307-857-4383
Practice Address - Street 1:#24 GREAT PLAINS ROAD
Practice Address - Street 2:
Practice Address - City:ARAPAHOE
Practice Address - State:WY
Practice Address - Zip Code:82510
Practice Address - Country:US
Practice Address - Phone:307-856-0470
Practice Address - Fax:307-857-4383
Is Sole Proprietor?:No
Enumeration Date:2016-04-14
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator