Provider Demographics
NPI:1801547906
Name:EVANS, DONNA ROSS (MS, RDN)
Entity type:Individual
Prefix:MS
First Name:DONNA
Middle Name:ROSS
Last Name:EVANS
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 WYNDOT CIR
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-8152
Mailing Address - Country:US
Mailing Address - Phone:318-237-3732
Mailing Address - Fax:
Practice Address - Street 1:100 CENTURYLINK DR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-2041
Practice Address - Country:US
Practice Address - Phone:318-582-7272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-11
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA912673133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered