Provider Demographics
NPI:1447488572
Name:EVOLA, JOSEFINE LAMPASONA (MS, RD)
Entity type:Individual
Prefix:MRS
First Name:JOSEFINE
Middle Name:LAMPASONA
Last Name:EVOLA
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:MS
Other - First Name:JOSEFINE
Other - Middle Name:
Other - Last Name:LAMPASONA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD
Mailing Address - Street 1:22201 MOROSS
Mailing Address - Street 2:SUITE 150
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48236
Mailing Address - Country:US
Mailing Address - Phone:313-886-8787
Mailing Address - Fax:313-886-8084
Practice Address - Street 1:25710 KELLY RD
Practice Address - Street 2:SUITE 3
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-4959
Practice Address - Country:US
Practice Address - Phone:586-291-5669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-27
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
947399133V00000X
MI947399133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered