Individual
NICHOLAS JAMES EVON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
259 MACK AVE, DETROIT, MI 48201-2427
(313) 577-1716
Mailing address
259 MACK AVE, DETROIT, MI 48201-2427
(313) 577-1716
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
4704309634
MI
207L00000X
Anesthesiology Physician
4704309634
MI
367500000X
Certified Registered Nurse Anesthetist
Primary
4704309634
MI
Other
Enumeration date
07/08/2022
Last updated
10/26/2023
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