MEDICARE: MISS MELISSA MAE EVANS PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant

General Provider Information

NPI Number	:	1225584790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MELISSA MAE EVANS PA

Provider Business Mailing Address
First Line	:	7700 E PARHAM RD
Second Line	:
City	:	HENRICO
State	:	VA
Zip	:	23294-4301
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7700 E PARHAM RD
Second Line	:
City	:	HENRICO
State	:	VA
Zip	:	23294-4301
Country	:	US
Telephone Number	:	804-314-1663
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2016
Last Update Date	:	11/30/2016

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