Provider Demographics
NPI:1801157938
Name:EVANS, LENORA M (DO)
Entity type:Individual
Prefix:
First Name:LENORA
Middle Name:M
Last Name:EVANS
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:LENORA
Other - Middle Name:M
Other - Last Name:EVANS HOLLMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:550 S LANDMARK AVE
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-3239
Practice Address - Country:US
Practice Address - Phone:812-330-3689
Practice Address - Fax:812-355-3290
Is Sole Proprietor?:No
Enumeration Date:2012-06-05
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY390200000X
IN02004643A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201294060Medicaid
IN201294060Medicaid
INQ00614965OtherRAILROAD PTAN
KYK101282Medicare PIN