Healthcare Provider Details

I. General information

NPI: 1083037717
Provider Name (Legal Business Name): AMANDA EVANS D.V.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2014
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3748 10TH ST NE
WASHINGTON DC
20017-1820
US

IV. Provider business mailing address

3748 10TH ST NE
WASHINGTON DC
20017-1820
US

V. Phone/Fax

Practice location:
  • Phone: 202-827-1230
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number090009642
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: