MEDICARE: BETSY JEAN EVANS

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	376K00000X	Nurse's Aide	402029821217	OH

General Provider Information

NPI Number	:	1306526280
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETSY JEAN EVANS

Provider Business Mailing Address
First Line	:	8977 LIBERTY ST
Second Line	:
City	:	UNION CITY
State	:	OH
Zip	:	45390-9075
Country	:	US
Telephone Number	:	765-913-1150
Fax Number	:

Provider Business Practice Location Address
First Line	:	8977 LIBERTY ST
Second Line	:
City	:	UNION CITY
State	:	OH
Zip	:	45390-9075
Country	:	US
Telephone Number	:	765-913-1150
Fax Number	:

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

Provider Enumeration Date	:	07/24/2023
Last Update Date	:	07/24/2023

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