Provider Demographics
NPI:1295583417
Name:EVIZA-FORD, KATHLEEN F (MSN, RN-BC, RN)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:F
Last Name:EVIZA-FORD
Suffix:
Gender:F
Credentials:MSN, RN-BC, RN
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:F
Other - Last Name:EVIZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, RN-BC, RN
Mailing Address - Street 1:880 FOUNTAIN CT APT D
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-1847
Mailing Address - Country:US
Mailing Address - Phone:434-987-1569
Mailing Address - Fax:
Practice Address - Street 1:880 FOUNTAIN CT APT D
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-1847
Practice Address - Country:US
Practice Address - Phone:434-987-1569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95236360163W00000X
VA1284468163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse