Provider Demographics
NPI:1922267947
Name:EVANSON, SANDY HAN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:SANDY
Middle Name:HAN
Last Name:EVANSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:SANDY
Other - Middle Name:KIM
Other - Last Name:HAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2415 MUSGROVE RD
Mailing Address - Street 2:STE 105
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-5224
Mailing Address - Country:US
Mailing Address - Phone:804-484-2098
Mailing Address - Fax:
Practice Address - Street 1:2415 MUSGROVE RD STE 105
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-5224
Practice Address - Country:US
Practice Address - Phone:301-989-0193
Practice Address - Fax:301-989-3464
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0004770363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant