Provider Demographics
NPI:1821985540
Name:RENFROE, EVITA HANAYO (LPN)
Entity type:Individual
Prefix:
First Name:EVITA
Middle Name:HANAYO
Last Name:RENFROE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 COLLINS RUN DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30157-0207
Mailing Address - Country:US
Mailing Address - Phone:770-344-9607
Mailing Address - Fax:
Practice Address - Street 1:22 COLLINS RUN DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30157-0207
Practice Address - Country:US
Practice Address - Phone:770-344-9607
Practice Address - Fax:770-344-9607
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-24
Last Update Date:2025-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN073238164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse