Basic Information
| Provider Information | |||||||||
| NPI: | 1003142464 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EVANS | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | L.V.N. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2603 LAS MERCEDES LANE | ||||||||
| Address2: | |||||||||
| City: | CORONA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92880 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7142626201 | ||||||||
| FaxNumber: | 9493611669 | ||||||||
| Practice Location | |||||||||
| Address1: | 2603 LAS MERCEDES LN | ||||||||
| Address2: | |||||||||
| City: | CORONA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928797798 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7142626201 | ||||||||
| FaxNumber: | 9493611669 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2009 | ||||||||
| LastUpdateDate: | 10/20/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164X00000X | 167180 | CA | Y | Nursing Service Providers | Licensed Vocational Nurse |
No ID Information.