Healthcare Provider Details

I. General information

NPI: 1235212432
Provider Name (Legal Business Name): JOSEPH EVANS PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

985450 NEBRASKA MEDICAL CTR
OMAHA NE
68198-5450
US

IV. Provider business mailing address

985450 NEBRASKA MEDICAL CTR
OMAHA NE
68198-5450
US

V. Phone/Fax

Practice location:
  • Phone: 402-559-8943
  • Fax:
Mailing address:
  • Phone: 402-559-8943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number351
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: