Provider Demographics
NPI:1780227025
Name:AMBION, EVELYN (LVN)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:
Last Name:AMBION
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7016 RAWLEY WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-4039
Mailing Address - Country:US
Mailing Address - Phone:916-709-4105
Mailing Address - Fax:
Practice Address - Street 1:7016 RAWLEY WAY
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95757-4039
Practice Address - Country:US
Practice Address - Phone:916-709-4105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-18
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN144222164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse