Healthcare Provider Details

I. General information

NPI: 1033220355
Provider Name (Legal Business Name): MARCIA HYATT EVANS MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 W OWENS AVE
LAS VEGAS NV
89106-2516
US

IV. Provider business mailing address

8971 FORT CRESTWOOD DR
LAS VEGAS NV
89129-3639
US

V. Phone/Fax

Practice location:
  • Phone: 702-636-3000
  • Fax: 702-636-4078
Mailing address:
  • Phone: 702-396-9953
  • Fax: 702-396-9953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberNS00912
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: