Provider Demographics
NPI:1881888071
Name:EVANS, KELLI ELAINE (LVN)
Entity type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:ELAINE
Last Name:EVANS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 HOWE AVE
Mailing Address - Street 2:BLDG. 200
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-4731
Mailing Address - Country:US
Mailing Address - Phone:916-993-4131
Mailing Address - Fax:916-993-4887
Practice Address - Street 1:650 HOWE AVE
Practice Address - Street 2:BLDG. 200
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-4731
Practice Address - Country:US
Practice Address - Phone:916-993-4131
Practice Address - Fax:916-993-4887
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-30
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA280180164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse