Provider Demographics
NPI:1881461911
Name:EVANS, ETHAN (WRAPAROUND)
Entity type:Individual
Prefix:
First Name:ETHAN
Middle Name:
Last Name:EVANS
Suffix:
Gender:M
Credentials:WRAPAROUND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7580 CASTLETON FARMS WEST DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-1942
Mailing Address - Country:US
Mailing Address - Phone:317-750-5838
Mailing Address - Fax:
Practice Address - Street 1:2506 WILLOWBROOK PKWY STE 111
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46205-1542
Practice Address - Country:US
Practice Address - Phone:317-574-1254
Practice Address - Fax:317-674-0060
Is Sole Proprietor?:No
Enumeration Date:2023-12-08
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator