Healthcare Provider Details

I. General information

NPI: 1245597459
Provider Name (Legal Business Name): LAURA EVANS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2012
Last Update Date: 09/30/2020
Certification Date: 09/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1455 NW IRVING ST STE 600
PORTLAND OR
97209-2277
US

IV. Provider business mailing address

1389 HUFFMAN ROAD #150
ANCHORAGE AK
99515
US

V. Phone/Fax

Practice location:
  • Phone: 844-966-6463
  • Fax:
Mailing address:
  • Phone: 888-227-3312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201350043NP
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1287
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: