Healthcare Provider Details

I. General information

NPI: 1649675497
Provider Name (Legal Business Name): LEDAWN EVANS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2014
Last Update Date: 10/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7001A EAST PKWY 250
SACRAMENTO CA
95823-2501
US

IV. Provider business mailing address

7001A EAST PKWY 250
SACRAMENTO CA
95823-2501
US

V. Phone/Fax

Practice location:
  • Phone: 916-876-8852
  • Fax:
Mailing address:
  • Phone: 916-876-8852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374700000X
TaxonomyTechnician
License NumberCPT70276
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: