Provider Demographics
NPI:1033220355
Name:EVANS, MARCIA HYATT (MSN)
Entity Type:Individual
Prefix:MS
First Name:MARCIA
Middle Name:HYATT
Last Name:EVANS
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8971 FORT CRESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-3639
Mailing Address - Country:US
Mailing Address - Phone:702-396-9953
Mailing Address - Fax:702-396-9953
Practice Address - Street 1:912 W OWENS AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-2516
Practice Address - Country:US
Practice Address - Phone:702-636-3000
Practice Address - Fax:702-636-4078
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNS00912163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHNS-00912OtherCLINICAL NURSE SPECIALIST
NVRN32673Medicare UPIN
OHRN160235Medicare UPIN