Healthcare Provider Details

I. General information

NPI: 1144165945
Provider Name (Legal Business Name): KEREN ELIZABETH EVANS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2688 ROSE CITY RD
LUPTON MI
48635-9716
US

IV. Provider business mailing address

2688 ROSE CITY RD
LUPTON MI
48635-9716
US

V. Phone/Fax

Practice location:
  • Phone: 989-701-0043
  • Fax:
Mailing address:
  • Phone: 989-701-0043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704196967
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: