Healthcare Provider Details

I. General information

NPI: 1306898200
Provider Name (Legal Business Name): GLORIA ANN EVANS N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

631 MAIN STREET
BETHEL AK
99559
US

IV. Provider business mailing address

631 MAIN STREET PO BOX 1908
BETHEL AK
99559
US

V. Phone/Fax

Practice location:
  • Phone: 907-543-3773
  • Fax: 907-543-3545
Mailing address:
  • Phone: 907-543-3773
  • Fax: 907-543-3545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number514
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: