Provider Demographics
NPI:1528510344
Name:EVANS, JESSICA DIANE (LPN)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:DIANE
Last Name:EVANS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 WEST FIREWEED LANE
Mailing Address - Street 2:SUITE 160
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503
Mailing Address - Country:US
Mailing Address - Phone:907-770-0862
Mailing Address - Fax:
Practice Address - Street 1:670 WEST FIREWEED LANE
Practice Address - Street 2:SUITE 160
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503
Practice Address - Country:US
Practice Address - Phone:907-770-0862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-27
Last Update Date:2022-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKNURP346164W00000X
AK6346164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse