MEDICARE: EVON LACHELLE DUBOSE

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	LPN.159193.MEDS-IV	OH
2	163W00000X	Registered Nurse	RN.505522	OH

General Provider Information

NPI Number	:	1134696537
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVON LACHELLE DUBOSE

Provider Business Mailing Address
First Line	:	941 YALE ST
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44311-1933
Country	:	US
Telephone Number	:	330-937-1024
Fax Number	:

Provider Business Practice Location Address
First Line	:	941 YALE ST
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44311-1933
Country	:	US
Telephone Number	:	330-937-1024
Fax Number	:

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

Provider Enumeration Date	:	10/24/2018
Last Update Date	:	08/01/2024

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Directions to “ EVON LACHELLE DUBOSE ” Practice Location

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