Healthcare Provider Details

I. General information

NPI: 1417206186
Provider Name (Legal Business Name): MICHELE ANN EVANS CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2012
Last Update Date: 09/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 E BROAD ST
COLUMBUS OH
43213-1502
US

IV. Provider business mailing address

18 MURPHYS VIEW PL
POWELL OH
43065-6032
US

V. Phone/Fax

Practice location:
  • Phone: 614-234-6000
  • Fax:
Mailing address:
  • Phone: 614-406-1762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number307548
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number13781-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: