Provider Demographics
NPI:1134499965
Name:EVANS RAYACK, SAMANTHA EVELYNE (ND, CPM)
Entity type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:EVELYNE
Last Name:EVANS RAYACK
Suffix:
Gender:F
Credentials:ND, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1471 PEARL ST STE 2
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-4603
Mailing Address - Country:US
Mailing Address - Phone:541-338-9494
Mailing Address - Fax:541-338-8496
Practice Address - Street 1:1471 PEARL ST STE 2
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4603
Practice Address - Country:US
Practice Address - Phone:541-338-9494
Practice Address - Fax:541-338-8496
Is Sole Proprietor?:No
Enumeration Date:2012-01-10
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4039175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath