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NPI Code Detail

MEDICARE: BRENDA EVANS

MEDICARE: BRENDA EVANS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialist

General Provider Information

NPI Number : 1093186843
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRENDA EVANS
Provider Business Mailing Address
First Line : 2141 OVERLOOK RD
Second Line :
City : CLEVELAND HEIGHTS
State : OH
Zip : 44106-5995
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2141 OVERLOOK RD
Second Line :
City : CLEVELAND HEIGHTS
State : OH
Zip : 44106-5995
Country : US
Telephone Number : 651-645-5323
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/19/2015
Last Update Date : 10/19/2015

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Directions to “ BRENDA EVANS ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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