Provider Demographics
NPI:1841924032
Name:EXPLORE THE EVANS EXPERIENCE LLC
Entity type:Organization
Organization Name:EXPLORE THE EVANS EXPERIENCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEONTYNE
Authorized Official - Middle Name:LYNNETTE
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:PLMHP, PLADC
Authorized Official - Phone:402-830-1780
Mailing Address - Street 1:5858 WENNINGHOFF RD STE 3
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68134-1911
Mailing Address - Country:US
Mailing Address - Phone:531-466-2482
Mailing Address - Fax:
Practice Address - Street 1:5858 WENNINGHOFF RD STE 3
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68134-1911
Practice Address - Country:US
Practice Address - Phone:531-466-2482
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-13
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center