Healthcare Provider Details

I. General information

NPI: 1639983851
Provider Name (Legal Business Name): EVAN MICHAEL ESCOTT FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2025
Last Update Date: 02/06/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5570 STATE ST
SAGINAW MI
48603-3583
US

IV. Provider business mailing address

9240 FRANKENMUTH RD
VASSAR MI
48768-9414
US

V. Phone/Fax

Practice location:
  • Phone: 989-583-0100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704355228
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: