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NPI Code Detail

MEDICARE: PRESHIA HEATHER EVANS

MEDICARE: PRESHIA HEATHER 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
1363A00000XPhysician Assistant5270CT

General Provider Information

NPI Number : 1780255406
Entity Type Code : Individual
Provider Name (Legal Business Name) : PRESHIA HEATHER EVANS
Provider Business Mailing Address
First Line : 117 WINDSOR AVE
Second Line :
City : MERIDEN
State : CT
Zip : 06451-2903
Country : US
Telephone Number : 203-935-7834
Fax Number :
Provider Business Practice Location Address
First Line : 380 MAIN ST
Second Line :
City : WATERTOWN
State : CT
Zip : 06795-2260
Country : US
Telephone Number : 860-274-8891
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/03/2021
Last Update Date : 07/03/2021

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Directions to “ PRESHIA HEATHER EVANS ” Practice Location

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