Provider Demographics
NPI:1972499515
Name:DELGADO-EVENSEN, LAURA SUE (TN17240903007)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:SUE
Last Name:DELGADO-EVENSEN
Suffix:
Gender:F
Credentials:TN17240903007
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:SUE
Other - Last Name:EVENSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:600 CATOOSA RD
Mailing Address - Street 2:
Mailing Address - City:WARTBURG
Mailing Address - State:TN
Mailing Address - Zip Code:37887-4033
Mailing Address - Country:US
Mailing Address - Phone:423-539-6825
Mailing Address - Fax:423-539-6825
Practice Address - Street 1:600 CATOOSA RD
Practice Address - Street 2:
Practice Address - City:WARTBURG
Practice Address - State:TN
Practice Address - Zip Code:37887-4033
Practice Address - Country:US
Practice Address - Phone:423-539-6825
Practice Address - Fax:423-539-6825
Is Sole Proprietor?:No
Enumeration Date:2025-06-17
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN17240903007376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide