Healthcare Provider Details

I. General information

NPI: 1366767071
Provider Name (Legal Business Name): JENNIFER EVANS RDCS, RVT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2010
Last Update Date: 06/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 CLINTON DR
STONEWALL LA
71078-5405
US

IV. Provider business mailing address

275 CLINTON DR
STONEWALL LA
71078-5405
US

V. Phone/Fax

Practice location:
  • Phone: 225-235-1710
  • Fax: 888-880-6308
Mailing address:
  • Phone: 225-235-1710
  • Fax: 888-880-6308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246XS1301X
TaxonomySonography Specialist/Technologist Cardiovascular
License NumberARDMS119468
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code2471V0105X
TaxonomyVascular Sonography Radiologic Technologist
License NumberARDMS119468
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: