Healthcare Provider Details

I. General information

NPI: 1831468081
Provider Name (Legal Business Name): JOHN EVANS, ARNP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2011
Last Update Date: 12/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 GAGE BLVD SUITE 101
RICHLAND WA
99352-8650
US

IV. Provider business mailing address

560 GAGE BLVD SUITE 101
RICHLAND WA
99352-8650
US

V. Phone/Fax

Practice location:
  • Phone: 509-628-2843
  • Fax: 509-628-3843
Mailing address:
  • Phone: 509-628-2843
  • Fax: 509-628-3843

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: JOHN EVANS
Title or Position: OWNER
Credential: ARNP
Phone: 509-628-2843