Provider Demographics
NPI:1164967568
Name:EVANS, ZJIA ANITA MANZANARES (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:ZJIA
Middle Name:ANITA MANZANARES
Last Name:EVANS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:ZJIA
Other - Middle Name:ANITA
Other - Last Name:MANZANARES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:425 PINE RIDGE BLVD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-4123
Mailing Address - Country:US
Mailing Address - Phone:715-845-5505
Mailing Address - Fax:715-848-2884
Practice Address - Street 1:425 PINE RIDGE BLVD
Practice Address - Street 2:SUITE 211
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-4123
Practice Address - Country:US
Practice Address - Phone:715-845-5505
Practice Address - Fax:715-848-2884
Is Sole Proprietor?:No
Enumeration Date:2016-12-21
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI232331163W00000X
WI114055367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse