Provider Demographics
NPI:1083884266
Name:EVANS, JOHN M (FNP)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:EVANS
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:PORTOLA
Mailing Address - State:CA
Mailing Address - Zip Code:96122-9405
Mailing Address - Country:US
Mailing Address - Phone:530-284-6116
Mailing Address - Fax:
Practice Address - Street 1:480 1ST AVE
Practice Address - Street 2:
Practice Address - City:PORTOLA
Practice Address - State:CA
Practice Address - Zip Code:96122-9405
Practice Address - Country:US
Practice Address - Phone:530-832-6600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA285993163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse