Provider Demographics
NPI:1508042250
Name:EVANS, LAUREN ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:ELIZABETH
Last Name:EVANS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 RAINIER AVE S
Mailing Address - Street 2:SUITE B
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-4623
Mailing Address - Country:US
Mailing Address - Phone:206-328-0546
Mailing Address - Fax:206-328-0489
Practice Address - Street 1:2120 RAINIER AVE S
Practice Address - Street 2:SUITE B
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144-4623
Practice Address - Country:US
Practice Address - Phone:206-328-0546
Practice Address - Fax:206-328-0489
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-11
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00023634208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1089366Medicaid
WAA06108Medicare UPIN
WA1089366Medicaid