Provider Demographics
NPI:1316132301
Name:EVANS, HEATHER ROCHELLE (RN OCN)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:ROCHELLE
Last Name:EVANS
Suffix:
Gender:F
Credentials:RN OCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16960 CONNECTOR RD
Mailing Address - Street 2:
Mailing Address - City:FREDERICKTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:43019-9711
Mailing Address - Country:US
Mailing Address - Phone:740-694-6706
Mailing Address - Fax:
Practice Address - Street 1:16960 CONNECTOR RD
Practice Address - Street 2:
Practice Address - City:FREDERICKTOWN
Practice Address - State:OH
Practice Address - Zip Code:43019-9711
Practice Address - Country:US
Practice Address - Phone:740-694-6706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN 273705163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2539588Medicaid