Provider Demographics
NPI:1821546912
Name:EVENS, ELIZABETH FAYE (RN)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:FAYE
Last Name:EVENS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:ELIZABETH
Other - Middle Name:FAYE
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2876 QUINCY RD
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IN
Mailing Address - Zip Code:47456-8621
Mailing Address - Country:US
Mailing Address - Phone:317-902-9397
Mailing Address - Fax:
Practice Address - Street 1:455 S LANDMARK AVE
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-5004
Practice Address - Country:US
Practice Address - Phone:812-336-5723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-16
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28185437A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse