Healthcare Provider Details

I. General information

NPI: 1083539373
Provider Name (Legal Business Name): EVAN SCOTT RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 MERCANTILE DR STE 900A
RANCHO CORDOVA CA
95742-6574
US

IV. Provider business mailing address

2700 MERCANTILE DR STE 900A
RANCHO CORDOVA CA
95742-6574
US

V. Phone/Fax

Practice location:
  • Phone: 800-650-4003
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number95045908
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: