Mackenzie Marie Evans
Student in an Organized Health Care Education/Training Program in Reston, VA. Individual provider (NPI-1).
NPI number1063930683
StatusActive
Last updated in NPPESSep 4, 2017
Details
- NPI
- 1063930683
- Entity type
- Individual (NPI-1)
- Name
- Mackenzie Marie Evans
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Sep 4, 2017
- Last updated
- Sep 4, 2017
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 390200000X | Student in an Organized Health Care Education/Training Program | – | – | Yes |
| 2255A2300X | Specialist/Technologist, Athletic Trainer | – | – |
Practice location
2380 Branleigh Park CtReston, VA 20191
Phone 703-945-7327
Mailing address
2380 Branleigh Park CtReston, VA 20191
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