MEDICARE: COURTNEY JUNG HAE EVANS

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	363LF0000X	Family Nurse Practitioner	95028318	CA

General Provider Information

NPI Number	:	1518726405
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY JUNG HAE EVANS

Provider Business Mailing Address
First Line	:	10828 CHARING CROSS RD
Second Line	:
City	:	SPRING VALLEY
State	:	CA
Zip	:	91978-1208
Country	:	US
Telephone Number	:	317-469-8619
Fax Number	:

Provider Business Practice Location Address
First Line	:	7895 BROADWAY
Second Line	:
City	:	LEMON GROVE
State	:	CA
Zip	:	91945-1803
Country	:	US
Telephone Number	:	619-692-0734
Fax Number	:

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

Provider Enumeration Date	:	03/14/2024
Last Update Date	:	03/14/2024

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Directions to “ COURTNEY JUNG HAE EVANS ” Practice Location

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