Healthcare Provider Details

I. General information

NPI: 1841470879
Provider Name (Legal Business Name): CINDY STOCK EVANS A.P.R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2007
Last Update Date: 11/09/2022
Certification Date: 11/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 N 300 W STE 101
PROVO UT
84604-3381
US

IV. Provider business mailing address

3550 N UNIVERSITY AVE SUTIE #250
PROVO UT
84604-6683
US

V. Phone/Fax

Practice location:
  • Phone: 801-852-3460
  • Fax:
Mailing address:
  • Phone: 801-374-9625
  • Fax: 801-374-9690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4973545-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: