Provider Demographics
NPI:1164506960
Name:EVANS, JANET (PNP)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3141 N 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-4360
Mailing Address - Country:US
Mailing Address - Phone:602-914-1520
Mailing Address - Fax:602-914-1521
Practice Address - Street 1:3141 N 3RD AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4360
Practice Address - Country:US
Practice Address - Phone:602-914-1520
Practice Address - Fax:602-914-1521
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ75363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ542573Medicaid
AZ542573Medicaid