Provider Demographics
NPI:1205683026
Name:EVANS, ERIN ELIZABETH
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:ELIZABETH
Last Name:EVANS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 74870
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99707-4870
Mailing Address - Country:US
Mailing Address - Phone:907-371-9818
Mailing Address - Fax:
Practice Address - Street 1:753 GAFFNEY RD
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4609
Practice Address - Country:US
Practice Address - Phone:907-371-9818
Practice Address - Fax:907-374-4709
Is Sole Proprietor?:No
Enumeration Date:2024-04-30
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator