Provider Demographics
NPI:1255721445
Name:ST JEAN, EVELYN (RN)
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:
Last Name:ST JEAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JJ
Other - Middle Name:HEALTH CARE
Other - Last Name:SYSTEMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:41 MAPLEWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02302-1934
Mailing Address - Country:US
Mailing Address - Phone:508-818-1986
Mailing Address - Fax:
Practice Address - Street 1:41 MAPLEWOOD CIR
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02302-1934
Practice Address - Country:US
Practice Address - Phone:508-818-1986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-27
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA256258163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse