Provider Demographics
NPI:1285213918
Name:EVANS, TANYSHA
Entity Type:Individual
Prefix:
First Name:TANYSHA
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 1:1321 S NEVADA HIGHWAY 160 STE 10B
Mailing Address - Street 2:
Mailing Address - City:PAHRUMP
Mailing Address - State:NV
Mailing Address - Zip Code:89048-4763
Mailing Address - Country:US
Mailing Address - Phone:775-910-9061
Mailing Address - Fax:
Practice Address - Street 1:1321 S NEVADA HIGHWAY 160 STE 10B
Practice Address - Street 2:
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89048-4763
Practice Address - Country:US
Practice Address - Phone:775-910-9061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-08
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant