Provider Demographics
NPI:1174201115
Name:EVANS, BREYONEA ALONGA
Entity type:Individual
Prefix:
First Name:BREYONEA
Middle Name:ALONGA
Last Name:EVANS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2884 HARRISON AVE APT 12
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45211-7174
Mailing Address - Country:US
Mailing Address - Phone:513-915-3056
Mailing Address - Fax:
Practice Address - Street 1:2884 HARRISON AVE APT 12
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45211-7174
Practice Address - Country:US
Practice Address - Phone:513-915-3056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty