Provider Demographics
NPI:1386908523
Name:EVANS, JEANNE MATRONA
Entity type:Individual
Prefix:MS
First Name:JEANNE
Middle Name:MATRONA
Last Name:EVANS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:JEANNE
Other - Middle Name:MATRONA
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 528
Mailing Address - Street 2:DD SERVICES
Mailing Address - City:BETHEL
Mailing Address - State:AK
Mailing Address - Zip Code:99559-0528
Mailing Address - Country:US
Mailing Address - Phone:907-543-1287
Mailing Address - Fax:
Practice Address - Street 1:460 RIDGECREST
Practice Address - Street 2:SUITE 215
Practice Address - City:BETHEL
Practice Address - State:AK
Practice Address - Zip Code:99559
Practice Address - Country:US
Practice Address - Phone:907-543-1287
Practice Address - Fax:907-543-3152
Is Sole Proprietor?:No
Enumeration Date:2012-07-03
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator