Provider Demographics
NPI:1982221594
Name:ANGUS, EVAN WILLIAMS (CRNA)
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:WILLIAMS
Last Name:ANGUS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:340 THOMAS MORE PKWY STE 220
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW HILLS
Mailing Address - State:KY
Mailing Address - Zip Code:41017-5101
Mailing Address - Country:US
Mailing Address - Phone:859-301-2211
Mailing Address - Fax:859-301-2511
Practice Address - Street 1:1 MEDICAL VILLAGE DR
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017-3403
Practice Address - Country:US
Practice Address - Phone:859-301-2000
Practice Address - Fax:859-341-7867
Is Sole Proprietor?:No
Enumeration Date:2020-06-30
Last Update Date:2020-07-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY3014754367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered