Provider Demographics
NPI:1992396816
Name:EVANS, ANGELICA MONA
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:MONA
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 1:6034 RICHMOND HWY APT 716
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22303-2115
Mailing Address - Country:US
Mailing Address - Phone:571-835-2477
Mailing Address - Fax:
Practice Address - Street 1:6034 RICHMOND HWY APT 716
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22303-2115
Practice Address - Country:US
Practice Address - Phone:571-835-2477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide