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NPI Code Detail

MEDICARE: MR. BRIAN EVANS

MEDICARE: MR. BRIAN EVANS
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
1172V00000XCommunity Health Worker
2171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1366142838
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. BRIAN EVANS
Provider Business Mailing Address
First Line : 4457 C ST SE
Second Line :
City : WASHINGTON
State : DC
Zip : 20019-4384
Country : US
Telephone Number : 202-904-3782
Fax Number :
Provider Business Practice Location Address
First Line : 4457 C ST SE
Second Line :
City : WASHINGTON
State : DC
Zip : 20019-4384
Country : US
Telephone Number : 202-904-3782
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/03/2023
Last Update Date : 06/06/2023

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