Basic Information
| Provider Information | |||||||||
| NPI: | 1669916896 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EVANS | ||||||||
| FirstName: | JENNIFER | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 READS WAY | ||||||||
| Address2: | SUITE #201 | ||||||||
| City: | NEW CASTLE | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197201630 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3027094709 | ||||||||
| FaxNumber: | 3023569304 | ||||||||
| Practice Location | |||||||||
| Address1: | 4755 OGLETOWN STANTON RD | ||||||||
| Address2: | |||||||||
| City: | NEWARK | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197180002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3027331100 | ||||||||
| FaxNumber: | 3027332865 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/07/2016 | ||||||||
| LastUpdateDate: | 03/03/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | L1-0037109 | DE | Y | Nursing Service Providers | Registered Nurse |
No ID Information.