Healthcare Provider Details

I. General information

NPI: 1326383050
Provider Name (Legal Business Name): CHLORA LEIGH EVANS R.N
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2012
Last Update Date: 12/19/2024
Certification Date: 12/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 TWINING ST BLDG 760
MONTGOMERY AL
36112-6027
US

IV. Provider business mailing address

300 TWINING ST BLDG 760
MONTGOMERY AL
36112-6027
US

V. Phone/Fax

Practice location:
  • Phone: 334-953-5270
  • Fax:
Mailing address:
  • Phone: 334-953-5270
  • Fax: 334-953-3258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number1-038997
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code163WC1600X
TaxonomyContinuing Education/Staff Development Registered Nurse
License Number1-038997
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code163WN1003X
TaxonomyNutrition Support Registered Nurse
License Number1-038997
License Number StateAL
# 4
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-038997
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: