Provider Demographics
NPI:1740624873
Name:EVANS, SHERYLL DIANE
Entity type:Individual
Prefix:MRS
First Name:SHERYLL
Middle Name:DIANE
Last Name:EVANS
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:SHERYLL
Other - Middle Name:DIANE
Other - Last Name:STCLAIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:6155 FOUNTAIN VALLEY SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80911-2251
Mailing Address - Country:US
Mailing Address - Phone:719-391-5225
Mailing Address - Fax:719-391-5230
Practice Address - Street 1:6155 FOUNTAIN VALLEY SCHOOL RD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80911-2251
Practice Address - Country:US
Practice Address - Phone:719-390-7035
Practice Address - Fax:719-391-5230
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-19
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO114686163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse