Healthcare Provider Details

I. General information

NPI: 1417038472
Provider Name (Legal Business Name): JEAN ELLEN EVANS M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 E WOODLAWN RD SUITE 150
CHARLOTTE NC
28217-2202
US

IV. Provider business mailing address

210 E WOODLAWN RD SUITE 150
CHARLOTTE NC
28217-2202
US

V. Phone/Fax

Practice location:
  • Phone: 704-523-8027
  • Fax: 704-523-8031
Mailing address:
  • Phone: 704-523-8027
  • Fax: 704-523-8031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number6443
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: