Provider Demographics
NPI:1285377259
Name:EVENS, SUZANNE MARIE
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:MARIE
Last Name:EVENS
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:PO BOX 166
Mailing Address - Street 2:
Mailing Address - City:DUKE CENTER
Mailing Address - State:PA
Mailing Address - Zip Code:16729-0166
Mailing Address - Country:US
Mailing Address - Phone:814-598-5333
Mailing Address - Fax:
Practice Address - Street 1:20 GRANT ST
Practice Address - Street 2:
Practice Address - City:DUKE CENTER
Practice Address - State:PA
Practice Address - Zip Code:16729-9611
Practice Address - Country:US
Practice Address - Phone:814-598-5333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-18
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA420043416L0300X
PA146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
No3416L0300XTransportation ServicesAmbulanceLand Transport