Provider Demographics
NPI:1013172451
Name:EVANS, TERESA MARIE (ND, LM)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:MARIE
Last Name:EVANS
Suffix:
Gender:F
Credentials:ND, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15808 MILL CREEK BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-1500
Mailing Address - Country:US
Mailing Address - Phone:425-673-3420
Mailing Address - Fax:425-673-3423
Practice Address - Street 1:15808 MILL CREEK BLVD STE 200
Practice Address - Street 2:
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-1500
Practice Address - Country:US
Practice Address - Phone:425-673-3420
Practice Address - Fax:425-673-3423
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-24
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT 60020664175F00000X
WAMW60071418367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No175F00000XOther Service ProvidersNaturopath