Provider Demographics
NPI:1669666855
Name:EVANS, CINDY RENEE (NP)
Entity Type:Individual
Prefix:MS
First Name:CINDY
Middle Name:RENEE
Last Name:EVANS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CINDY
Other - Middle Name:RENEE
Other - Last Name:PERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1676
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47308-1676
Mailing Address - Country:US
Mailing Address - Phone:765-286-7000
Mailing Address - Fax:765-213-2769
Practice Address - Street 1:3715 S MADISON ST
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47302-5756
Practice Address - Country:US
Practice Address - Phone:765-286-7000
Practice Address - Fax:765-213-2769
Is Sole Proprietor?:No
Enumeration Date:2007-08-30
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001715A363L00000X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN466980WMedicare PIN