Provider Demographics
NPI:1942360763
Name:LAUREN E. EVANS, M.D., P.S.
Entity Type:Organization
Organization Name:LAUREN E. EVANS, M.D., P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-328-0546
Mailing Address - Street 1:2120 RAINIER AVE S
Mailing Address - Street 2:SUITE B
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-4623
Mailing Address - Country:US
Mailing Address - Phone:206-328-0456
Mailing Address - Fax:206-328-0489
Practice Address - Street 1:2120 RAINIER AVE S
Practice Address - Street 2:SUITE B
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144-4623
Practice Address - Country:US
Practice Address - Phone:206-328-0456
Practice Address - Fax:206-328-0489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00023634261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1089366Medicaid
WA1089366Medicaid
WAG000106354Medicare PIN