Healthcare Provider Details

I. General information

NPI: 1932500907
Provider Name (Legal Business Name): BILLIE DENISE EVINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2014
Last Update Date: 09/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3497 VALERIE ARMS DR 728
DAYTON OH
45405-2152
US

IV. Provider business mailing address

3497 VALERIE ARMS DR 728
DAYTON OH
45405-2152
US

V. Phone/Fax

Practice location:
  • Phone: 937-422-3714
  • Fax:
Mailing address:
  • Phone: 937-422-3714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number401061340310
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: