Provider Demographics
NPI:1952742769
Name:EVANS, NICOLE ANN (MED)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:ANN
Last Name:EVANS
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 TAUNTON GRN
Mailing Address - Street 2:SUITE 5
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-3243
Mailing Address - Country:US
Mailing Address - Phone:508-880-6615
Mailing Address - Fax:
Practice Address - Street 1:30 TAUNTON GRN
Practice Address - Street 2:SUITE 5
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-3243
Practice Address - Country:US
Practice Address - Phone:508-880-6615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-09
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health