Provider Demographics
NPI:1336947944
Name:ALEXIS, EVENS
Entity type:Individual
Prefix:
First Name:EVENS
Middle Name:
Last Name:ALEXIS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 W CRYSTAL BROOK DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01118-1948
Mailing Address - Country:US
Mailing Address - Phone:857-370-9722
Mailing Address - Fax:
Practice Address - Street 1:130 W CRYSTAL BROOK DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01118-1948
Practice Address - Country:US
Practice Address - Phone:857-370-9722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-07
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician