Healthcare Provider Details

I. General information

NPI: 1366912230
Provider Name (Legal Business Name): EVAN ALEXANDRA GLOVER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2018
Last Update Date: 01/11/2024
Certification Date: 01/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1435 GARRISON ST STE 110
LAKEWOOD CO
80215-4748
US

IV. Provider business mailing address

17507 W 61ST LN
ARVADA CO
80403-7456
US

V. Phone/Fax

Practice location:
  • Phone: 720-241-3765
  • Fax: 720-310-7216
Mailing address:
  • Phone: 207-218-7333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5650
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0005650
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: