Provider Demographics
NPI:1972679736
Name:TREADWELL, EVANGELINE RABARA (CRNA)
Entity Type:Individual
Prefix:
First Name:EVANGELINE
Middle Name:RABARA
Last Name:TREADWELL
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:EVANGELINE
Other - Middle Name:
Other - Last Name:RABARA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:3115 COLLEGE PARK DR 107
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77384-4001
Mailing Address - Country:US
Mailing Address - Phone:936-494-3003
Mailing Address - Fax:
Practice Address - Street 1:2411 FOUNTAIN VIEW DR
Practice Address - Street 2:SUITE 200
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-4817
Practice Address - Country:US
Practice Address - Phone:903-530-9591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX685367367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8669UUOtherBLUE CROSS BLUE SHIELD
TX155476803Medicaid
TX89664UOtherBCBS
TX155476803Medicaid
TX8L16478Medicare PIN
TX8L20410Medicare PIN
TX8L6111Medicare PIN