Provider Demographics
NPI:1962246157
Name:EVICKS, AWNA JONAE (RN)
Entity type:Individual
Prefix:
First Name:AWNA
Middle Name:JONAE
Last Name:EVICKS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 N BURL DR
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-2105
Mailing Address - Country:US
Mailing Address - Phone:559-572-7133
Mailing Address - Fax:
Practice Address - Street 1:500 N SANTA FE ST
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93292-5065
Practice Address - Country:US
Practice Address - Phone:559-684-8703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-21
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95159877163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse