Provider Demographics
NPI:1205725801
Name:EVANS, JONVOANA ROTRESH
Entity type:Individual
Prefix:
First Name:JONVOANA
Middle Name:ROTRESH
Last Name:EVANS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13106 HAMPTON FARM LN
Mailing Address - Street 2:
Mailing Address - City:BRANDYWINE
Mailing Address - State:MD
Mailing Address - Zip Code:20613-5812
Mailing Address - Country:US
Mailing Address - Phone:443-415-6051
Mailing Address - Fax:
Practice Address - Street 1:3200 CRAIN HWY STE 205
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-4843
Practice Address - Country:US
Practice Address - Phone:240-435-4345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-30
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach