Provider Demographics
NPI:1699263608
Name:EVANS, JERALINE RACHELE (LSC)
Entity type:Individual
Prefix:MRS
First Name:JERALINE
Middle Name:RACHELE
Last Name:EVANS
Suffix:
Gender:F
Credentials:LSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 WEST FRANKLIN STREET (YMCA OF GREATER RICHMOND)
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23220
Mailing Address - Country:US
Mailing Address - Phone:804-644-9622
Mailing Address - Fax:
Practice Address - Street 1:151 MCINTIRE PARK DR. (PIEDMONT FAMILY YMCA)
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22902
Practice Address - Country:US
Practice Address - Phone:434-974-9622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-25
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator