Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 71003791A | IN |
NPI | 1013286699 |
---|---|
Provider Name | Ms. Chasity R Evans |
First Address | Muncie, IN 47303-3421 |
Second Address | Muncie, IN 47303-3421 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2011 |
Last Update Date | 13/02/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201043570 | (05) | IN |