Provider Demographics
NPI:1578070264
Name:EVANS, EMMA MICHELLE
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:MICHELLE
Last Name:EVANS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:EMMA
Other - Middle Name:MICHELLE
Other - Last Name:BETZOLD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2849 E MALIBU DR
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-1518
Mailing Address - Country:US
Mailing Address - Phone:989-501-5971
Mailing Address - Fax:
Practice Address - Street 1:3279 KING CT
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-1666
Practice Address - Country:US
Practice Address - Phone:989-501-5971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-04
Last Update Date:2018-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker