Healthcare Provider Details

I. General information

NPI: 1174349286
Provider Name (Legal Business Name): NICHOLAS EVANS LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2024
Last Update Date: 11/23/2024
Certification Date: 11/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3209 E 57TH AVE
SPOKANE WA
99223-7040
US

IV. Provider business mailing address

1131 E 32ND AVE
SPOKANE WA
99203-3119
US

V. Phone/Fax

Practice location:
  • Phone: 509-448-9398
  • Fax:
Mailing address:
  • Phone: 509-866-2933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA61629675
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: