Provider Demographics
NPI:1205806890
Name:EVANS, MARK STEVEN (REGISTERED NURSE)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:STEVEN
Last Name:EVANS
Suffix:
Gender:M
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 NORDALE RD N
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99712-3243
Mailing Address - Country:US
Mailing Address - Phone:907-384-0763
Mailing Address - Fax:907-384-0607
Practice Address - Street 1:724 POSTAL SERVICE LOOP
Practice Address - Street 2:
Practice Address - City:FORT RICHARDSON
Practice Address - State:AK
Practice Address - Zip Code:99505-5001
Practice Address - Country:US
Practice Address - Phone:907-384-0763
Practice Address - Fax:907-384-0607
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK23870163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse