MEDICARE: DESTINY NICOLE 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	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1801759972
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DESTINY NICOLE EVANS

Provider Business Mailing Address
First Line	:	1722 GRAND AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43607-1611
Country	:	US
Telephone Number	:	567-290-8085
Fax Number	:

Provider Business Practice Location Address
First Line	:	1722 GRAND AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43607-1611
Country	:	US
Telephone Number	:	567-290-8085
Fax Number	:

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

Provider Enumeration Date	:	12/05/2025
Last Update Date	:	12/05/2025

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Directions to “ DESTINY NICOLE EVANS ” Practice Location

Language	Start Address	Practice Location

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