MEDICARE: MS. CHLORA LEIGH EVANS R.N

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	163WC0400X	Case Management Registered Nurse	1-038997	AL
2	163WC1600X	Continuing Education/Staff Development Registered Nurse	1-038997	AL
3	163WN1003X	Nutrition Support Registered Nurse	1-038997	AL
4	163W00000X	Registered Nurse	1-038997	AL

General Provider Information

NPI Number	:	1326383050
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHLORA LEIGH EVANS R.N

Provider Business Mailing Address
First Line	:	300 TWINING ST BLDG 760
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36112-6027
Country	:	US
Telephone Number	:	334-953-5270
Fax Number	:	334-953-3258

Provider Business Practice Location Address
First Line	:	300 TWINING ST BLDG 760
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36112-6027
Country	:	US
Telephone Number	:	334-953-5270
Fax Number	:

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

Provider Enumeration Date	:	12/06/2012
Last Update Date	:	12/19/2024

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