Healthcare Provider Details

I. General information

NPI: 1376797803
Provider Name (Legal Business Name): NANCY GOEBEL EVANS RNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2008
Last Update Date: 05/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3883 AIRWAY DR STE 165 SUITE 3
SANTA ROSA CA
95403-1675
US

IV. Provider business mailing address

1643 SCENIC LN
HEALDSBURG CA
95448-4535
US

V. Phone/Fax

Practice location:
  • Phone: 707-521-8930
  • Fax: 707-523-1305
Mailing address:
  • Phone: 707-433-3587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number296481
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: