Healthcare Provider Details

I. General information

NPI: 1386497550
Provider Name (Legal Business Name): ASHANTI EVANS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2024
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 E MAIN ST
LANCASTER OH
43130-3808
US

IV. Provider business mailing address

PO BOX 243
SUGAR GROVE OH
43155-0243
US

V. Phone/Fax

Practice location:
  • Phone: 614-404-6008
  • Fax:
Mailing address:
  • Phone: 614-404-6008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: