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General NPI Number Information
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NPI Number | 1902561756
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Entity Type | Individual
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Provider Name | MINERVA D EVANS LPN
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Gender | Female
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Dates
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Enumeration Date | 11/06/2021
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Last Update Date | 11/06/2021
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Provider Practice Location Address
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Address Line | 34290 FORD RD
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City | WESTLAND
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State | MI
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Zip | 48185-3051
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Country | US
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Telephone | 734-412-8800
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Fax | 313-396-5353
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Provider Business Mailing Address
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Address Line | 16300 N PARK DR APT 1501
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City | SOUTHFIELD
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State | MI
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Zip | 48075-4724
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Country | US
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Telephone | 248-996-3748
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 4703080643
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License Number State | MI
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