Provider Demographics
NPI:1407399645
Name:IMAH, EVELYNE MOTUE
Entity Type:Individual
Prefix:MRS
First Name:EVELYNE
Middle Name:MOTUE
Last Name:IMAH
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 1:5700 SAINT THOMAS DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75094-4620
Mailing Address - Country:US
Mailing Address - Phone:214-636-5837
Mailing Address - Fax:
Practice Address - Street 1:5076 W PLANO PKWY
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-4471
Practice Address - Country:US
Practice Address - Phone:972-733-0095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-20
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP132617363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily