Provider Demographics
NPI:1851735427
Name:CHATTERTON, EVAN S
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:S
Last Name:CHATTERTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2217 W 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-5402
Mailing Address - Country:US
Mailing Address - Phone:509-768-0784
Mailing Address - Fax:
Practice Address - Street 1:2217 W 4TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-5402
Practice Address - Country:US
Practice Address - Phone:509-768-0784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-24
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN 60332857163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse