Provider Demographics
NPI:1194226944
Name:EVANS, MONTA MILLS
Entity Type:Individual
Prefix:
First Name:MONTA
Middle Name:MILLS
Last Name:EVANS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 N MERIDIAN ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:IN
Mailing Address - Zip Code:46052-1807
Mailing Address - Country:US
Mailing Address - Phone:435-512-1291
Mailing Address - Fax:
Practice Address - Street 1:2791 N LEBANON ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:IN
Practice Address - Zip Code:46052-2299
Practice Address - Country:US
Practice Address - Phone:765-483-9622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-27
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator