Healthcare Provider Details

I. General information

NPI: 1811981988
Provider Name (Legal Business Name): JOHN EVANS ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2005
Last Update Date: 10/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 GOETHALS DRIVE SUITE B
RICHLAND WA
99352
US

IV. Provider business mailing address

560 GAGE BLVD SUITE 203
RICHLAND WA
99352
US

V. Phone/Fax

Practice location:
  • Phone: 509-942-3080
  • Fax: 509-942-3085
Mailing address:
  • Phone: 509-942-3627
  • Fax: 509-942-2268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP30005529
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: