Healthcare Provider Details

I. General information

NPI: 1497983415
Provider Name (Legal Business Name): CONI LEE EVANS R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CONI NELSON EVANS R.N.

II. Dates (important events)

Enumeration Date: 06/29/2009
Last Update Date: 06/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

745 W MOANA LN
RENO NV
89509-4991
US

IV. Provider business mailing address

4375 FAIRVIEW RD
RENO NV
89511-6523
US

V. Phone/Fax

Practice location:
  • Phone: 775-334-3033
  • Fax: 775-334-3022
Mailing address:
  • Phone: 775-853-1060
  • Fax: 775-853-1060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN14812
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN14812
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN14812
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: