Provider Demographics
NPI:1386250090
Name:EVANS, WANDA HARVEY
Entity type:Individual
Prefix:
First Name:WANDA
Middle Name:HARVEY
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 1:212 NELSON LN
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27527-3980
Mailing Address - Country:US
Mailing Address - Phone:919-585-2100
Mailing Address - Fax:919-249-2157
Practice Address - Street 1:212 NELSON LN
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27527-3980
Practice Address - Country:US
Practice Address - Phone:919-585-2100
Practice Address - Fax:919-249-2157
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-17
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula