Provider Demographics
NPI:1154982395
Name:SCHRAGER, EVELYN MARIE (RDHAP)
Entity type:Individual
Prefix:MRS
First Name:EVELYN
Middle Name:MARIE
Last Name:SCHRAGER
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 E WOODHAVEN LN
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-1209
Mailing Address - Country:US
Mailing Address - Phone:559-307-1810
Mailing Address - Fax:
Practice Address - Street 1:803 E WOODHAVEN LN
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-1209
Practice Address - Country:US
Practice Address - Phone:559-307-1810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-27
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA640125K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes125K00000XDental ProvidersAdvanced Practice Dental TherapistGroup - Single Specialty