Provider Demographics
NPI:1316271117
Name:EVANS, AMBERLY GRACE (RN)
Entity type:Individual
Prefix:
First Name:AMBERLY
Middle Name:GRACE
Last Name:EVANS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:AMBERLY
Other - Middle Name:GRACE
Other - Last Name:KUEHNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:677 HUBBARD RD
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:OH
Mailing Address - Zip Code:43119-9462
Mailing Address - Country:US
Mailing Address - Phone:614-949-9565
Mailing Address - Fax:
Practice Address - Street 1:677 HUBBARD RD
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:OH
Practice Address - Zip Code:43119-9462
Practice Address - Country:US
Practice Address - Phone:614-949-9565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-25
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN . 282608163W00000X, 163WC0200X, 163WE0003X, 163WG0000X, 163WH0200X, 163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163W00000XNursing Service ProvidersRegistered Nurse
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WP0200XNursing Service ProvidersRegistered NursePediatrics