Provider Demographics
NPI:1295150795
Name:VAN KIRK, EVANGELINE L (STNA)
Entity type:Individual
Prefix:MS
First Name:EVANGELINE
Middle Name:L
Last Name:VAN KIRK
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19350 ORMISTON AVE
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44119-1517
Mailing Address - Country:US
Mailing Address - Phone:216-571-4032
Mailing Address - Fax:
Practice Address - Street 1:19350 ORMISTON AVE
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44119-1517
Practice Address - Country:US
Practice Address - Phone:216-571-4032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-20
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health