Provider Demographics
NPI:1740613934
Name:EVANS, MARY KAREN (CARE PROVIDER)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:KAREN
Last Name:EVANS
Suffix:
Gender:F
Credentials:CARE PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3115 ARTHUR DR
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86404-9742
Mailing Address - Country:US
Mailing Address - Phone:928-279-3100
Mailing Address - Fax:
Practice Address - Street 1:3115 ARTHUR DR
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86404-9742
Practice Address - Country:US
Practice Address - Phone:928-279-3100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker