Provider Demographics
NPI:1871856104
Name:EVANS, SARAH L (MT RN)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:L
Last Name:EVANS
Suffix:
Gender:F
Credentials:MT RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15930 INDIANAPOLIS RD
Mailing Address - Street 2:
Mailing Address - City:YODER
Mailing Address - State:IN
Mailing Address - Zip Code:46798-9517
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1212 MAGNAVOX WAY
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-1566
Practice Address - Country:US
Practice Address - Phone:260-466-2979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-21
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INMT20902452173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist