Provider Demographics
NPI:1275921405
Name:EVAN, LUCY (CHA-III)
Entity Type:Individual
Prefix:
First Name:LUCY
Middle Name:
Last Name:EVAN
Suffix:
Gender:F
Credentials:CHA-III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 CLINIC ROAD
Mailing Address - Street 2:
Mailing Address - City:GOODNEWS BAY
Mailing Address - State:AK
Mailing Address - Zip Code:99589-0155
Mailing Address - Country:US
Mailing Address - Phone:907-967-8128
Mailing Address - Fax:907-967-8928
Practice Address - Street 1:155 CLINIC ROAD
Practice Address - Street 2:
Practice Address - City:GOODNEWS BAY
Practice Address - State:AK
Practice Address - Zip Code:99589-0155
Practice Address - Country:US
Practice Address - Phone:907-967-8128
Practice Address - Fax:907-967-8928
Is Sole Proprietor?:No
Enumeration Date:2014-12-22
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK14-1306-III172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker