Provider Demographics
NPI:1558109637
Name:BARNETT, EVAN
Entity type:Individual
Prefix:
First Name:EVAN
Middle Name:
Last Name:BARNETT
Suffix:
Gender:U
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2549 E EASTGATE LN APT 106
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47408-3913
Mailing Address - Country:US
Mailing Address - Phone:812-457-4407
Mailing Address - Fax:
Practice Address - Street 1:2549 E EASTGATE LN APT 106
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47408-3913
Practice Address - Country:US
Practice Address - Phone:812-457-4407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program