Provider Demographics
NPI:1336728229
Name:DAFFORN, EVELYN JEANNINE (NBC-HWC)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:JEANNINE
Last Name:DAFFORN
Suffix:
Gender:F
Credentials:NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3635 S URBANA LISBON RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:OH
Mailing Address - Zip Code:45368-8762
Mailing Address - Country:US
Mailing Address - Phone:937-207-6050
Mailing Address - Fax:
Practice Address - Street 1:3635 S URBANA LISBON RD
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:OH
Practice Address - Zip Code:45368-8762
Practice Address - Country:US
Practice Address - Phone:937-207-6050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA-3369207