Provider Demographics
NPI:1215383419
Name:EVANS, EISA
Entity Type:Individual
Prefix:
First Name:EISA
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 E 18TH AVE
Mailing Address - Street 2:APT 11
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-4174
Mailing Address - Country:US
Mailing Address - Phone:650-575-3072
Mailing Address - Fax:
Practice Address - Street 1:500 E 18TH AVE
Practice Address - Street 2:APT 11
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4174
Practice Address - Country:US
Practice Address - Phone:650-575-3072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-06
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other