Provider Demographics
NPI:1942317037
Name:EVANS, DONNA P (NP)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:P
Last Name:EVANS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:834 FARRAR DR
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-8747
Mailing Address - Country:US
Mailing Address - Phone:843-347-9487
Mailing Address - Fax:843-347-9574
Practice Address - Street 1:834 FARRAR DR
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-8747
Practice Address - Country:US
Practice Address - Phone:843-347-9487
Practice Address - Fax:843-347-9574
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2968363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC20055544OtherSELECT HEALTH
NC7003984Medicaid
SCNP1018Medicaid
SCP00403923OtherRAIL ROAD MEDICARE
SCAA15178516OtherMEDICARE
SCQ71317Medicare UPIN