Healthcare Provider Details

I. General information

NPI: 1114367372
Provider Name (Legal Business Name): MARA S EVANS M.S., M.ED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2013
Last Update Date: 07/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 GULLY LN
E SANDWICH MA
02537-1304
US

IV. Provider business mailing address

14 GULLY LN
E SANDWICH MA
02537-1304
US

V. Phone/Fax

Practice location:
  • Phone: 508-888-6217
  • Fax:
Mailing address:
  • Phone: 508-888-6217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number248842
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: