Provider Demographics
NPI:1841593191
Name:EVARTS, DAWN MICHELLE (LAC, EAMP)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:MICHELLE
Last Name:EVARTS
Suffix:
Gender:F
Credentials:LAC, EAMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 BUTLER AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WA
Mailing Address - Zip Code:98272-1527
Mailing Address - Country:US
Mailing Address - Phone:360-805-1555
Mailing Address - Fax:360-805-9029
Practice Address - Street 1:365 BUTLER AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272-1527
Practice Address - Country:US
Practice Address - Phone:360-805-1555
Practice Address - Fax:360-805-9029
Is Sole Proprietor?:No
Enumeration Date:2010-12-08
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60193058171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAC60193058OtherSTATE LICENSE