Provider Demographics
NPI:1891933115
Name:EVANSRT(, KAYE ARLENE (RT(R)MR)
Entity Type:Individual
Prefix:MRS
First Name:KAYE
Middle Name:ARLENE
Last Name:EVANSRT(
Suffix:
Gender:F
Credentials:RT(R)MR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9273 NATURE VIEW LANE
Mailing Address - Street 2:
Mailing Address - City:YPSILLANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-1400
Mailing Address - Country:US
Mailing Address - Phone:734-434-4629
Mailing Address - Fax:
Practice Address - Street 1:9273 NATURE VIEW LANE
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1400
Practice Address - Country:US
Practice Address - Phone:734-434-4620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-23
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker