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General NPI Number Information
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NPI Number | 1164183448
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Entity Type | Individual
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Provider Name | DIANE LATONYA EVANS
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Gender | Female
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Dates
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Enumeration Date | 01/07/2022
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Last Update Date | 09/16/2022
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Provider Practice Location Address
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Address Line | 4301 LAMPLIGHTER CT
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23234-3427
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Country | US
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Telephone | 757-434-4326
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Fax |
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Provider Business Mailing Address
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Address Line | 9507 HULL STREET RD STE G5
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23236-1254
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Country | US
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Telephone | 757-434-4326
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 1201144620
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License Number State | VA
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