Healthcare Provider Details

I. General information

NPI: 1285541003
Provider Name (Legal Business Name): ELIZABETH EVANS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131B STONY CIRCLE SUITE 1200
SANTA ROSA CA
95401
US

IV. Provider business mailing address

131B STONY CIRCLE SUITE 1200
SANTA ROSA CA
95401
US

V. Phone/Fax

Practice location:
  • Phone: 707-576-7700
  • Fax:
Mailing address:
  • Phone: 707-576-7700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: