Provider Demographics
NPI:1023844677
Name:ARNOLD, EVELYN ANNETTE
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:ANNETTE
Last Name:ARNOLD
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 1:25804 CRYSTALCREEK E
Mailing Address - Street 2:
Mailing Address - City:SOUTH LYON
Mailing Address - State:MI
Mailing Address - Zip Code:48178-2113
Mailing Address - Country:US
Mailing Address - Phone:248-961-2532
Mailing Address - Fax:
Practice Address - Street 1:25804 CRYSTALCREEK E
Practice Address - Street 2:
Practice Address - City:SOUTH LYON
Practice Address - State:MI
Practice Address - Zip Code:48178-2113
Practice Address - Country:US
Practice Address - Phone:248-961-2532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant