Healthcare Provider Details

I. General information

NPI: 1326672452
Provider Name (Legal Business Name): TANEASHA ELIZABETH EVANS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2020
Last Update Date: 02/27/2020
Certification Date: 02/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

438 HOBRON LN STE 405
HONOLULU HI
96815-1229
US

IV. Provider business mailing address

PO BOX 61541
HONOLULU HI
96839-1541
US

V. Phone/Fax

Practice location:
  • Phone: 808-941-9648
  • Fax:
Mailing address:
  • Phone: 805-304-4808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4120
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: