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NPI Code Detail

MEDICARE: DESHAWNDA EVANS

MEDICARE: DESHAWNDA 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
1225400000XRehabilitation Practitioner

General Provider Information

NPI Number : 1881041721
Entity Type Code : Individual
Provider Name (Legal Business Name) : DESHAWNDA EVANS
Provider Business Mailing Address
First Line : 3737 PECOS MCLEOD STE 103
Second Line :
City : LAS VEGAS
State : NV
Zip : 89121-4263
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3737 PECOS MCLEOD STE 103
Second Line :
City : LAS VEGAS
State : NV
Zip : 89121-4263
Country : US
Telephone Number : 702-433-3038
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/20/2016
Last Update Date : 05/20/2016

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Directions to “ DESHAWNDA EVANS ” Practice Location

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