Provider Demographics
NPI:1659815850
Name:EVANS, SUSAN JANE (RN)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:JANE
Last Name:EVANS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3836 SACRAMENTO ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-1626
Mailing Address - Country:US
Mailing Address - Phone:415-317-4855
Mailing Address - Fax:628-899-8322
Practice Address - Street 1:3836 SACRAMENTO ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-1626
Practice Address - Country:US
Practice Address - Phone:415-317-4855
Practice Address - Fax:628-899-8322
Is Sole Proprietor?:No
Enumeration Date:2016-12-07
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN199066101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health