Provider Demographics
NPI:1720865603
Name:EVANS, PRECIOUS T
Entity Type:Individual
Prefix:
First Name:PRECIOUS
Middle Name:T
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 1:16069 CARLISLE ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48205-1407
Mailing Address - Country:US
Mailing Address - Phone:586-405-3671
Mailing Address - Fax:
Practice Address - Street 1:606 S WILLIAMS ST APT 406
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-2647
Practice Address - Country:US
Practice Address - Phone:586-447-2728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-13
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
No376K00000XNursing Service Related ProvidersNurse's Aide