Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner | NV |
NPI | 1023360138 |
---|---|
Provider Name | Judy Evans |
First Address | Greenville, CA 95947-0554 |
Second Address | Greenville, CA 95947 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2012 |
Last Update Date | 12/10/2012 |