Provider Demographics
NPI:1689485120
Name:EVELE, CORA JANE
Entity type:Individual
Prefix:
First Name:CORA
Middle Name:JANE
Last Name:EVELE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4164 BLACKFOOT DR SW
Mailing Address - Street 2:
Mailing Address - City:GRANDVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49418-1723
Mailing Address - Country:US
Mailing Address - Phone:616-466-1076
Mailing Address - Fax:
Practice Address - Street 1:1524 E BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-2933
Practice Address - Country:US
Practice Address - Phone:989-854-8334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-15
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician