Provider Demographics
NPI:1558107078
Name:EVANS, VANESSA NOEL
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:NOEL
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 1:61 PERRY STANLEY RD
Mailing Address - Street 2:
Mailing Address - City:HARDY
Mailing Address - State:KY
Mailing Address - Zip Code:41531-8722
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:61 PERRY STANLEY RD
Practice Address - Street 2:
Practice Address - City:HARDY
Practice Address - State:KY
Practice Address - Zip Code:41531-8722
Practice Address - Country:US
Practice Address - Phone:304-733-1094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-03
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant