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General NPI Number Information
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NPI Number | 1609657816
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Entity Type | Individual
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Provider Name | EVELINA AVETISOVA AGPC-NP
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Gender | Female
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Dates
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Enumeration Date | 10/12/2023
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Last Update Date | 09/17/2025
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Provider Practice Location Address
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Address Line | 15214 AURORA AVE N
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City | SHORELINE
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State | WA
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Zip | 98133-6143
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Country | US
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Telephone | 888-405-6396
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Fax | 415-252-7176
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Provider Business Mailing Address
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Address Line | 104 SOLOMON RD APT G302
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City | KELSO
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State | WA
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Zip | 98626-1772
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Country | US
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Telephone | 323-372-4190
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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 | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 10017243
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | AP61494666
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License Number State | WA
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