Individual
SHANUN JANIECE EVANS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12051 MCCLINTOCK CT, ALBANY, GA 31705-4447
(216) 854-1011
Mailing address
12051 MCCLINTOCK CT, ALBANY, GA 31705-4447
(216) 854-1011
Taxonomy
Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
Primary
C102408
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C102408
COSMETOLOGY
NC
Enumeration date
12/20/2020
Last updated
01/01/2021
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