Individual
LISA A EVANS-THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
20952 E 12 MILE RD, SUITE 200, SAINT CLAIR SHORES, MI 48081-3200
(586) 771-4820
(586) 771-6620
Mailing address
20952 E 12 MILE RD, SUITE 200, SAINT CLAIR SHORES, MI 48081-3200
(586) 771-4820
(586) 771-6620
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
4704130480
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CB9133
MEDICARE RAILROAD
MI
Enumeration date
10/26/2006
Last updated
06/26/2014
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