Individual
JACQUELINE MERYL EVANS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5801 BREMO RD, RICHMOND, VA 23226-1907
(916) 397-5585
Mailing address
6004 MANOR PARK TER, GLEN ALLEN, VA 23059-5496
(916) 397-5585
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
G87264
CA
2080P0203X
Pediatric Critical Care Medicine Physician
Primary
0101266378
VA
2080P0203X
Pediatric Critical Care Medicine Physician
MD-44596
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G872640
—
CA
Enumeration date
09/27/2006
Last updated
05/14/2022
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