Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 229963 | MA |
N | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 35095645 | OH |
Y | 207VG0400X | Gynecologist | 95645 | OH |
NPI | 1912058041 |
---|---|
Provider Name | Dr. Janelle Morgan Evans |
First Address | Centerville, OH 45459-4056 |
Second Address | Centerville, OH 45459-4056 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2007 |
Last Update Date | 27/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3114427 | (05) | OH |
35095645 | LICENSE (01) | OH |