Provider Demographics
NPI:1467888016
Name:EVELYN, KATHERINE LIND (RN, NP)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:LIND
Last Name:EVELYN
Suffix:
Gender:F
Credentials:RN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 LAVERNE AVE
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-3475
Mailing Address - Country:US
Mailing Address - Phone:415-419-1094
Mailing Address - Fax:
Practice Address - Street 1:228 LAVERNE AVE
Practice Address - Street 2:
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-3475
Practice Address - Country:US
Practice Address - Phone:415-419-1094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-15
Last Update Date:2013-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA271379363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health