Provider Demographics
NPI:1952633448
Name:EVANS, DEREK GWYN (CRNA)
Entity Type:Individual
Prefix:MR
First Name:DEREK
Middle Name:GWYN
Last Name:EVANS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4150 V ST STE 1200
Mailing Address - Street 2:PSSB SUITE 1200 ANESTHESIOLOGY & PAIN MEDICINE
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-1460
Mailing Address - Country:US
Mailing Address - Phone:916-734-5028
Mailing Address - Fax:
Practice Address - Street 1:4150 V ST STE 1200
Practice Address - Street 2:PSSB SUITE 1200 ANESTHESIOLOGY & PAIN MEDICINE
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-1460
Practice Address - Country:US
Practice Address - Phone:916-734-5028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-08
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA276242367500000X
CA95000142367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered