Provider Demographics
NPI:1831526748
Name:EVANS, HELENA KAY (R A)
Entity type:Individual
Prefix:MRS
First Name:HELENA
Middle Name:KAY
Last Name:EVANS
Suffix:
Gender:F
Credentials:R A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 ISLAND VIEW DR.
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE
Mailing Address - State:MI
Mailing Address - Zip Code:49696
Mailing Address - Country:US
Mailing Address - Phone:231-313-9633
Mailing Address - Fax:
Practice Address - Street 1:176 ISLAND VIEW DR.
Practice Address - Street 2:
Practice Address - City:TRAVERSE
Practice Address - State:MI
Practice Address - Zip Code:49696
Practice Address - Country:US
Practice Address - Phone:231-313-9633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-09
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MID3013N172V00000X
MI374U00000X374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI9674527Medicaid