Provider Demographics
NPI:1669015558
Name:EVANS, MARILEE (BS, RN)
Entity Type:Individual
Prefix:
First Name:MARILEE
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:BS, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 E STATE ROAD 44 STE B
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46176-4028
Mailing Address - Country:US
Mailing Address - Phone:317-392-6470
Mailing Address - Fax:317-392-6472
Practice Address - Street 1:1600 E STATE ROAD 44 STE B
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:IN
Practice Address - Zip Code:46176-4028
Practice Address - Country:US
Practice Address - Phone:317-392-6470
Practice Address - Fax:317-392-6472
Is Sole Proprietor?:No
Enumeration Date:2019-10-23
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28127122A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse