Provider Demographics
NPI:1902561756
Name:EVANS, MINERVA D (LPN)
Entity Type:Individual
Prefix:MISS
First Name:MINERVA
Middle Name:D
Last Name:EVANS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16300 N PARK DR APT 1501
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-4724
Mailing Address - Country:US
Mailing Address - Phone:248-996-3748
Mailing Address - Fax:
Practice Address - Street 1:34290 FORD RD
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-3051
Practice Address - Country:US
Practice Address - Phone:734-412-8800
Practice Address - Fax:313-396-5353
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-06
Last Update Date:2021-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703080643164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse