1831526748 NPI number — MRS. HELENA KAY EVANS R. A

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831526748 NPI number — MRS. HELENA KAY EVANS R. A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EVANS
Provider First Name:
HELENA
Provider Middle Name:
KAY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
R. A
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831526748
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/09/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
176 ISLAND VIEW DR.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TRAVERSE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49696
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
231-313-9633
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
176 ISLAND VIEW DR.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TRAVERSE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49696
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
231-313-9633
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/09/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 172V00000X , with the licence number:  D3013N , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 374U00000X , with the licence number: 374U00000X , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 9674527 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com