Provider Demographics
NPI:1275939043
Name:EVANS, LEASEL WAYNE (RN, MSN, PMHNP-BC)
Entity Type:Individual
Prefix:MR
First Name:LEASEL
Middle Name:WAYNE
Last Name:EVANS
Suffix:
Gender:M
Credentials:RN, MSN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 NW 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:CANBY
Mailing Address - State:OR
Mailing Address - Zip Code:97013-3517
Mailing Address - Country:US
Mailing Address - Phone:503-266-1407
Mailing Address - Fax:503-266-1849
Practice Address - Street 1:409 NW 2ND AVE
Practice Address - Street 2:
Practice Address - City:CANBY
Practice Address - State:OR
Practice Address - Zip Code:97013-3517
Practice Address - Country:US
Practice Address - Phone:503-266-1407
Practice Address - Fax:503-266-1849
Is Sole Proprietor?:No
Enumeration Date:2014-11-06
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201406240RN163WP0807X
OR201709151NP-PP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent