Healthcare Provider Details

I. General information

NPI: 1447118302
Provider Name (Legal Business Name): EVAN JOHN GEYER
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

826 W KING ST
OWOSSO MI
48867-2120
US

IV. Provider business mailing address

1152 W LAKE RD
CLIO MI
48420-8880
US

V. Phone/Fax

Practice location:
  • Phone: 989-720-2273
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704397486
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: