Provider Demographics
NPI:1174914576
Name:EVELAND, NOELLE JEANNE (LMT)
Entity type:Individual
Prefix:
First Name:NOELLE
Middle Name:JEANNE
Last Name:EVELAND
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9391 E 1 MILE RD
Mailing Address - Street 2:
Mailing Address - City:WHITE CLOUD
Mailing Address - State:MI
Mailing Address - Zip Code:49349-9242
Mailing Address - Country:US
Mailing Address - Phone:231-245-1614
Mailing Address - Fax:
Practice Address - Street 1:9391 E 1 MILE RD
Practice Address - Street 2:
Practice Address - City:WHITE CLOUD
Practice Address - State:MI
Practice Address - Zip Code:49349-9242
Practice Address - Country:US
Practice Address - Phone:231-245-1614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-07
Last Update Date:2015-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501006141225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist