Provider Demographics
NPI:1295359610
Name:EVANS, NIKI LEE
Entity Type:Individual
Prefix:
First Name:NIKI
Middle Name:LEE
Last Name:EVANS
Suffix:
Gender:M
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 1128
Mailing Address - Street 2:
Mailing Address - City:OROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95965-1128
Mailing Address - Country:US
Mailing Address - Phone:530-534-8693
Mailing Address - Fax:530-534-8690
Practice Address - Street 1:1224 ORO DAM BLVD W
Practice Address - Street 2:
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95965-4346
Practice Address - Country:US
Practice Address - Phone:530-534-8695
Practice Address - Fax:530-534-8690
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-01
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver