Provider Demographics
NPI:1366012452
Name:EVANS, JAMMIE LYNN (LPN)
Entity Type:Individual
Prefix:
First Name:JAMMIE
Middle Name:LYNN
Last Name:EVANS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7205 WAR RD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:MI
Mailing Address - Zip Code:48166-9309
Mailing Address - Country:US
Mailing Address - Phone:734-819-8636
Mailing Address - Fax:
Practice Address - Street 1:3250 N MONROE ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-9297
Practice Address - Country:US
Practice Address - Phone:734-384-3402
Practice Address - Fax:734-384-3420
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-30
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703121707164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse