Provider Demographics
NPI:1942897988
Name:EVANS, ADELE RENE
Entity Type:Individual
Prefix:MISS
First Name:ADELE
Middle Name:RENE
Last Name:EVANS
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 1:4380 ETHEL RD
Mailing Address - Street 2:
Mailing Address - City:OBETZ
Mailing Address - State:OH
Mailing Address - Zip Code:43207-4529
Mailing Address - Country:US
Mailing Address - Phone:614-352-5850
Mailing Address - Fax:
Practice Address - Street 1:3917 POPLAR BEND DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43204-5024
Practice Address - Country:US
Practice Address - Phone:614-352-5850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-23
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No376J00000XNursing Service Related ProvidersHomemaker