Healthcare Provider Details

I. General information

NPI: 1306526280
Provider Name (Legal Business Name): BETSY JEAN EVANS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2023
Last Update Date: 07/24/2023
Certification Date: 07/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8977 LIBERTY ST
UNION CITY OH
45390-9075
US

IV. Provider business mailing address

8977 LIBERTY ST
UNION CITY OH
45390-9075
US

V. Phone/Fax

Practice location:
  • Phone: 765-913-1150
  • Fax:
Mailing address:
  • Phone: 765-913-1150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number402029821217
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: