Healthcare Provider Details

I. General information

NPI: 1508106485
Provider Name (Legal Business Name): JOSHUA ROSS EVANS RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2013
Last Update Date: 10/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 E 23RD ST
CHEYENNE WY
82001-3748
US

IV. Provider business mailing address

4619 COTTAGE LN
CHEYENNE WY
82001-6792
US

V. Phone/Fax

Practice location:
  • Phone: 307-633-7701
  • Fax:
Mailing address:
  • Phone: 865-659-4474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279G1100X
TaxonomyGeneral Care Registered Respiratory Therapist
License NumberRTL0004127
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: