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General NPI Number Information
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NPI Number | 1326672452
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Entity Type | Individual
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Provider Name | TANEASHA ELIZABETH EVANS
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Gender | Female
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Dates
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Enumeration Date | 02/27/2020
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Last Update Date | 02/27/2020
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Provider Practice Location Address
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Address Line | 438 HOBRON LN STE 405
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City | HONOLULU
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State | HI
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Zip | 96815-1229
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Country | US
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Telephone | 808-941-9648
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 61541
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City | HONOLULU
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State | HI
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Zip | 96839-1541
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Country | US
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Telephone | 805-304-4808
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 4120
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License Number State | HI
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