Basic Information
| Provider Information | |||||||||
| NPI: | 1912058041 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EVANS | ||||||||
| FirstName: | JANELLE | ||||||||
| MiddleName: | MORGAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 7740 WASHINGTON VILLAGE DR STE 160 | ||||||||
| Address2: | |||||||||
| City: | CENTERVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454594056 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9374369825 | ||||||||
| FaxNumber: | 9374336508 | ||||||||
| Practice Location | |||||||||
| Address1: | 7740 WASHINGTON VILLAGE DR STE 160 | ||||||||
| Address2: | |||||||||
| City: | CENTERVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454594056 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9374369825 | ||||||||
| FaxNumber: | 9374336508 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/16/2007 | ||||||||
| LastUpdateDate: | 05/27/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VG0400X | 95645 | OH | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology | 207VF0040X | 35095645 | OH | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Female Pelvic Medicine and Reconstructive Surgery | 207V00000X | 229963 | MA | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 3114427 | 05 | OH | MEDICAID | 35095645 | 01 | OH | LICENSE | OTHER |