Provider Demographics
NPI:1104537430
Name:EVANS, MINDI LYNN
Entity type:Individual
Prefix:
First Name:MINDI
Middle Name:LYNN
Last Name:EVANS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3403 HEARTLAND ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-6393
Mailing Address - Country:US
Mailing Address - Phone:618-993-7790
Mailing Address - Fax:
Practice Address - Street 1:3403 HEARTLAND ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-6393
Practice Address - Country:US
Practice Address - Phone:618-993-7790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-07
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other