Basic Information
| Provider Information | |||||||||
| NPI: | 1366012452 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EVANS | ||||||||
| FirstName: | JAMMIE | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | LPN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7205 WAR RD | ||||||||
| Address2: | |||||||||
| City: | NEWPORT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481669309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7348198636 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3250 N MONROE ST | ||||||||
| Address2: | |||||||||
| City: | MONROE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481629297 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7343843402 | ||||||||
| FaxNumber: | 7343843420 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2021 | ||||||||
| LastUpdateDate: | 06/30/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | 4703121707 | MI | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.