Healthcare Provider Details

I. General information

NPI: 1871049080
Provider Name (Legal Business Name): EVELYN EAMES PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2016
Last Update Date: 08/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AMN HEALTHCARE 220 SOUTH ORANGE AVENUE
LIVINGSTON NJ
07039
US

IV. Provider business mailing address

832 PROVINCETOWN RD
AUBURN HILLS MI
48326-3449
US

V. Phone/Fax

Practice location:
  • Phone: 855-866-7038
  • Fax:
Mailing address:
  • Phone: 248-219-4106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number520001059
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number5502000056
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: