MEDICARE: WANDA JEAN EVANS RN

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	163W00000X	Registered Nurse	142897	OH

General Provider Information

NPI Number	:	1386914257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WANDA JEAN EVANS RN

Provider Business Mailing Address
First Line	:	1194 WIONNA AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45224-2116
Country	:	US
Telephone Number	:	513-681-3696
Fax Number	:	513-352-1429

Provider Business Practice Location Address
First Line	:	1194 WIONNA AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45224-2116
Country	:	US
Telephone Number	:	513-681-3696
Fax Number	:	513-352-1429

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

Provider Enumeration Date	:	01/09/2012
Last Update Date	:	01/09/2012

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