Individual
TANITA EVANS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
31 LEHIGH AVE, NEWARK, NJ 07112-2503
(973) 573-8150
Mailing address
31 LEHIGH AVE, NEWARK, NJ 07112-2503
(973) 573-8150
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
E95297320053802
NJ
Other
Enumeration date
09/08/2022
Last updated
09/08/2022
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