Provider Demographics
NPI:1659263630
Name:EVANS, NORTHERN ALLEN
Entity type:Individual
Prefix:
First Name:NORTHERN
Middle Name:ALLEN
Last Name:EVANS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 MAIN ST APT 712
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-2579
Mailing Address - Country:US
Mailing Address - Phone:304-215-4991
Mailing Address - Fax:
Practice Address - Street 1:601 MAIN ST APT 712
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-2579
Practice Address - Country:US
Practice Address - Phone:304-215-4991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-16
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant