Provider Demographics
NPI:1902377278
Name:EVANS, MELONEY DIANE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:MELONEY
Middle Name:DIANE
Last Name:EVANS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:MELONEY
Other - Middle Name:DIANE
Other - Last Name:TURPEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LVN
Mailing Address - Street 1:7741 LITTLEROCK RD. SW
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98512
Mailing Address - Country:US
Mailing Address - Phone:360-709-7896
Mailing Address - Fax:360-709-7802
Practice Address - Street 1:7741 LITTLEROCK RD. SW
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98512
Practice Address - Country:US
Practice Address - Phone:360-709-7896
Practice Address - Fax:360-709-7802
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN253289164X00000X
WALP60845980164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No164X00000XNursing Service ProvidersLicensed Vocational Nurse