Provider Demographics
NPI:1851823405
Name:EVANS, CANDICE A (LPN)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:A
Last Name:EVANS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3709 SAINT KEVIN PARK DR
Mailing Address - Street 2:
Mailing Address - City:SAINT ANN
Mailing Address - State:MO
Mailing Address - Zip Code:63074-2546
Mailing Address - Country:US
Mailing Address - Phone:314-337-5463
Mailing Address - Fax:
Practice Address - Street 1:3709 SAINT KEVIN PARK DR
Practice Address - Street 2:
Practice Address - City:SAINT ANN
Practice Address - State:MO
Practice Address - Zip Code:63074-2546
Practice Address - Country:US
Practice Address - Phone:314-337-5463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-03
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004011931164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse