Provider Demographics
NPI:1780574871
Name:EVENICH, ELENA ELIZABETH
Entity type:Individual
Prefix:
First Name:ELENA
Middle Name:ELIZABETH
Last Name:EVENICH
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 1:3628 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH HIGHLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:95660-5069
Mailing Address - Country:US
Mailing Address - Phone:916-326-5830
Mailing Address - Fax:
Practice Address - Street 1:3628 MADISON AVE
Practice Address - Street 2:
Practice Address - City:NORTH HIGHLANDS
Practice Address - State:CA
Practice Address - Zip Code:95660-5069
Practice Address - Country:US
Practice Address - Phone:916-326-5830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-08
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion