Healthcare Provider Details

I. General information

NPI: 1124005129
Provider Name (Legal Business Name): CATHERINE A EVANS PH D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2005
Last Update Date: 01/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 OFFICE PARK RD SUITE 301
WEST DES MOINES IA
50265-2587
US

IV. Provider business mailing address

1001 OFFICE PARK RD SUITE 301
WEST DES MOINES IA
50265-2587
US

V. Phone/Fax

Practice location:
  • Phone: 515-985-8209
  • Fax: 515-608-4405
Mailing address:
  • Phone: 515-985-8209
  • Fax: 515-608-4405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number00666
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number00258
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: