Provider Demographics
NPI:1689863045
Name:EVANS, MICHAEL WINSTON (CRNA)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:WINSTON
Last Name:EVANS
Suffix:
Gender:M
Credentials:CRNA
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Mailing Address - Street 1:755 N 11TH ST
Mailing Address - Street 2:STE P3600
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77702-1515
Mailing Address - Country:US
Mailing Address - Phone:409-724-7389
Mailing Address - Fax:337-433-9861
Practice Address - Street 1:2555 JIMMY JOHNSON BLVD
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77640-2007
Practice Address - Country:US
Practice Address - Phone:409-724-7389
Practice Address - Fax:409-853-5917
Is Sole Proprietor?:No
Enumeration Date:2007-10-22
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX675533367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX190753701Medicaid
TX190753701Medicaid