Healthcare Provider Details

I. General information

NPI: 1962688762
Provider Name (Legal Business Name): ELIZABETH EVANS N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2008
Last Update Date: 11/02/2023
Certification Date: 11/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

697 W TEFFT ST
NIPOMO CA
93444-9190
US

IV. Provider business mailing address

697 W TEFFT ST
NIPOMO CA
93444-9190
US

V. Phone/Fax

Practice location:
  • Phone: 805-929-2272
  • Fax: 805-929-6405
Mailing address:
  • Phone: 805-929-2272
  • Fax: 805-929-6405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number326358
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: