Provider Demographics
NPI:1235995960
Name:EVANS, BRENDA
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
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:PO BOX 258
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:OK
Mailing Address - Zip Code:74358-0258
Mailing Address - Country:US
Mailing Address - Phone:918-533-4401
Mailing Address - Fax:
Practice Address - Street 1:831 OAK
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:OK
Practice Address - Zip Code:74358
Practice Address - Country:US
Practice Address - Phone:918-533-4401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide