Healthcare Provider Details

I. General information

NPI: 1154170991
Provider Name (Legal Business Name): CRYSTAL DION EVANS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2024
Last Update Date: 05/14/2024
Certification Date: 05/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3436 MARY ELDER RD NE
OLYMPIA WA
98506-5050
US

IV. Provider business mailing address

1007 RUSTIC WAY
ABERDEEN WA
98520-1580
US

V. Phone/Fax

Practice location:
  • Phone: 360-528-2590
  • Fax:
Mailing address:
  • Phone: 360-581-6960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN00172271
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: