MEDICARE: DR. STELLA K. EVANS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	47409	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396712022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STELLA K. EVANS M.D.

Provider Business Mailing Address
First Line	:	3366 OAKDALE AVE N
Second Line	:	#501
City	:	ROBBINSDALE
State	:	MN
Zip	:	55422-2948
Country	:	US
Telephone Number	:	763-588-0758
Fax Number	:

Provider Business Practice Location Address
First Line	:	3366 OAKDALE AVE N
Second Line	:	#501
City	:	ROBBINSDALE
State	:	MN
Zip	:	55422-2948
Country	:	US
Telephone Number	:	763-588-0758
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/01/2006
Last Update Date	:	04/02/2012

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