Healthcare Provider Details

I. General information

NPI: 1801790498
Provider Name (Legal Business Name): MARISSA MARIS EVANS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

908 JEFFERSON ST
SEATTLE WA
98104-2433
US

IV. Provider business mailing address

5234 UNIVERSITY WAY NE APT 202
SEATTLE WA
98105-3557
US

V. Phone/Fax

Practice location:
  • Phone: 206-744-3000
  • Fax:
Mailing address:
  • Phone: 509-638-9480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number61147400
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: