Provider Demographics
NPI:1972128254
Name:EVANS, MIRANDA NASHAY
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:NASHAY
Last Name:EVANS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 SHERWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-2019
Mailing Address - Country:US
Mailing Address - Phone:318-250-4344
Mailing Address - Fax:
Practice Address - Street 1:821 SHERWOOD RD
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-2019
Practice Address - Country:US
Practice Address - Phone:318-250-4344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-11
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)