Provider Demographics
NPI:1669916896
Name:EVANS, JENNIFER (CRNA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 READS WAY
Mailing Address - Street 2:SUITE #201
Mailing Address - City:NEW CASTLE
Mailing Address - State:DE
Mailing Address - Zip Code:19720-1630
Mailing Address - Country:US
Mailing Address - Phone:302-709-4709
Mailing Address - Fax:302-356-9304
Practice Address - Street 1:4755 OGLETOWN STANTON RD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19718-0002
Practice Address - Country:US
Practice Address - Phone:302-733-1100
Practice Address - Fax:302-733-2865
Is Sole Proprietor?:No
Enumeration Date:2016-12-07
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL1-0037109163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse