Provider Demographics
NPI:1376868588
Name:EVANS, KATHY LYNNE (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:LYNNE
Last Name:EVANS
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-2526
Mailing Address - Country:US
Mailing Address - Phone:303-293-2220
Mailing Address - Fax:303-296-8826
Practice Address - Street 1:2100 BROADWAY
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-2526
Practice Address - Country:US
Practice Address - Phone:303-293-2220
Practice Address - Fax:303-296-8826
Is Sole Proprietor?:No
Enumeration Date:2010-03-30
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO116873163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO116873OtherREGISTERED NURSE