Provider Demographics
NPI:1457127045
Name:HENSLEY, EVELYN SUE (BSN RN)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:SUE
Last Name:HENSLEY
Suffix:
Gender:F
Credentials:BSN RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 BENEDUM RUN RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-7278
Mailing Address - Country:US
Mailing Address - Phone:304-669-2938
Mailing Address - Fax:
Practice Address - Street 1:2828 OLD ROUTE 33
Practice Address - Street 2:
Practice Address - City:HORNER
Practice Address - State:WV
Practice Address - Zip Code:26372-9705
Practice Address - Country:US
Practice Address - Phone:304-598-5151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV79265163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health