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General NPI Number Information
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NPI Number | 1912716630
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Entity Type | Individual
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Provider Name | MARISA LEEANNE EVANCHO APRN-CNP
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Gender | Female
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Dates
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Enumeration Date | 01/07/2025
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Last Update Date | 01/07/2025
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Provider Practice Location Address
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Address Line | 955 BETHESDA DR FL 1
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City | ZANESVILLE
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State | OH
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Zip | 43701-1840
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Country | US
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Telephone | 740-454-0804
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Fax | 740-454-7171
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Provider Business Mailing Address
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Address Line | 3800 MONA DR
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City | ZANESVILLE
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State | OH
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Zip | 43701-6900
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Country | US
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Telephone | 740-607-2302
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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 | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | APRN.CNP.0038395
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License Number State | OH
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