Provider Demographics
NPI:1841615671
Name:MEHLENBACHER, EVAN (CSB)
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:
Last Name:MEHLENBACHER
Suffix:
Gender:M
Credentials:CSB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72812 E 279 PRNE
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-7787
Mailing Address - Country:US
Mailing Address - Phone:509-374-3800
Mailing Address - Fax:509-628-9510
Practice Address - Street 1:72812 E 279 PRNE
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-7787
Practice Address - Country:US
Practice Address - Phone:509-374-3800
Practice Address - Fax:509-628-9510
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-04
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner