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General NPI Number Information
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NPI Number | 1265139331
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Entity Type | Individual
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Provider Name | EVAN JACKSON FROST EMT-B
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Gender | Male
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Dates
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Enumeration Date | 02/09/2023
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Last Update Date | 02/09/2023
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Provider Practice Location Address
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Address Line | 2052 GALISTEO ST
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City | SANTA FE
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State | NM
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Zip | 87505-2100
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Country | US
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Telephone | 505-819-3419
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Fax |
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Provider Business Mailing Address
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Address Line | 904 BISHOPS LODGE RD
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City | SANTA FE
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State | NM
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Zip | 87501-1131
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Country | US
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Telephone | 505-819-7317
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 146N00000X
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Taxonomy Name | Basic Emergency Medical Technician
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License Number | 1016380
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License Number State | MN
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