Provider Demographics
NPI:1225562093
Name:EVANS, MARGARET GRACE (MS, RDN)
Entity Type:Individual
Prefix:MISS
First Name:MARGARET
Middle Name:GRACE
Last Name:EVANS
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:MISS
Other - First Name:MAGGIE
Other - Middle Name:GRACE
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, RDN
Mailing Address - Street 1:1400 E. CHURCH STREET
Mailing Address - Street 2:MEDICAL STAFF OFFICE
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:316 S STRATFORD AVE
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-5908
Practice Address - Country:US
Practice Address - Phone:805-332-8446
Practice Address - Fax:805-332-8173
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-18
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86047660133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered