Provider Demographics
NPI:1548880073
Name:EVANS, SARA MERCEDES
Entity type:Individual
Prefix:MRS
First Name:SARA
Middle Name:MERCEDES
Last Name:EVANS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:SARA
Other - Middle Name:MERCEDES
Other - Last Name:THOMAS-MARTINEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5602 RAMBLEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-7346
Mailing Address - Country:US
Mailing Address - Phone:956-434-9627
Mailing Address - Fax:
Practice Address - Street 1:3901 BEAUBIEN ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2119
Practice Address - Country:US
Practice Address - Phone:313-745-1892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-24
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program