Provider Demographics
NPI:1386477628
Name:EVANS, TAMARA MEAGAN
Entity type:Individual
Prefix:MS
First Name:TAMARA
Middle Name:MEAGAN
Last Name:EVANS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SABRINA
Other - Middle Name:
Other - Last Name:ATHENA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:6311 HAGGERTY RD # 722
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-5031
Mailing Address - Country:US
Mailing Address - Phone:646-492-1708
Mailing Address - Fax:
Practice Address - Street 1:60 MCLEAN ST
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:MI
Practice Address - Zip Code:48203-3308
Practice Address - Country:US
Practice Address - Phone:646-492-1708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator