Provider Demographics
NPI:1508699711
Name:EVANS, QUINNMESHIA
Entity type:Individual
Prefix:
First Name:QUINNMESHIA
Middle Name:
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 1:72352 AMBER DR
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:IL
Mailing Address - Zip Code:46542-9534
Mailing Address - Country:US
Mailing Address - Phone:574-326-9166
Mailing Address - Fax:
Practice Address - Street 1:2606 PEDDLERS VILLAGE RD STE 218
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-1004
Practice Address - Country:US
Practice Address - Phone:574-326-9166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INBC22400817224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist