Individual
MS. GWENDOLYN LEA EVANS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
178 MILL RUN RD, LOT # 136, WAVERLY, OH 45690-9392
(740) 804-0446
Mailing address
178 MILL RUN RD, LOT # 136, WAVERLY, OH 45690-9392
(740) 804-0446
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN134577
OH
Other
Enumeration date
06/22/2012
Last updated
06/22/2012
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