MEDICARE: CHANTELLE ELIZABETH EVANS LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	L0069368	OK

General Provider Information

NPI Number	:	1134075427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHANTELLE ELIZABETH EVANS LPN

Provider Business Mailing Address
First Line	:	1601 DONALD AVE
Second Line	:
City	:	PONCA CITY
State	:	OK
Zip	:	74604-1412
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1601 DONALD AVE
Second Line	:
City	:	PONCA CITY
State	:	OK
Zip	:	74604-1412
Country	:	US
Telephone Number	:	580-670-4075
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2026
Last Update Date	:	03/09/2026

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