Provider Demographics
NPI:1366767071
Name:EVANS, JENNIFER (RDCS, RVT)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:RDCS, RVT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 CLINTON DR
Mailing Address - Street 2:
Mailing Address - City:STONEWALL
Mailing Address - State:LA
Mailing Address - Zip Code:71078-5405
Mailing Address - Country:US
Mailing Address - Phone:225-235-1710
Mailing Address - Fax:888-880-6308
Practice Address - Street 1:275 CLINTON DR
Practice Address - Street 2:
Practice Address - City:STONEWALL
Practice Address - State:LA
Practice Address - Zip Code:71078-5405
Practice Address - Country:US
Practice Address - Phone:225-235-1710
Practice Address - Fax:888-880-6308
Is Sole Proprietor?:No
Enumeration Date:2010-04-06
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAARDMS119468246XS1301X, 2471V0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular Sonography
No246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonography