Provider Demographics
NPI:1811610264
Name:EVANS, ROSELINE WAKALA (RN)
Entity type:Individual
Prefix:
First Name:ROSELINE
Middle Name:WAKALA
Last Name:EVANS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3330 BOURBON ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-7333
Mailing Address - Country:US
Mailing Address - Phone:540-455-7661
Mailing Address - Fax:
Practice Address - Street 1:3330 BOURBON ST
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-7333
Practice Address - Country:US
Practice Address - Phone:540-660-3353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-21
Last Update Date:2022-11-07
Deactivation Date:2022-10-24
Deactivation Code:
Reactivation Date:2022-11-07
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health