Provider Demographics
NPI:1184207524
Name:EVANS, CHRISTINA MARIE (BSM, LM, CPM)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:MARIE
Last Name:EVANS
Suffix:
Gender:F
Credentials:BSM, LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1745 MARILYN LN
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92069-9782
Mailing Address - Country:US
Mailing Address - Phone:208-771-1438
Mailing Address - Fax:
Practice Address - Street 1:1745 MARILYN LN
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92069-9782
Practice Address - Country:US
Practice Address - Phone:760-410-6499
Practice Address - Fax:760-452-4988
Is Sole Proprietor?:No
Enumeration Date:2021-05-03
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA638176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife