MEDICARE: DESIREE N 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
1	164X00000X	Licensed Vocational Nurse	353367	TX

General Provider Information

NPI Number	:	1477133197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DESIREE N EVANS

Provider Business Mailing Address
First Line	:	2727 TREBLE CRK APT 1024
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-4557
Country	:	US
Telephone Number	:	361-813-1232
Fax Number	:

Provider Business Practice Location Address
First Line	:	2727 TREBLE CRK APT 1024
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-4557
Country	:	US
Telephone Number	:	361-813-1232
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/08/2021
Last Update Date	:	04/08/2021

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Directions to “ DESIREE N EVANS ” Practice Location

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