Provider Demographics
NPI:1396891669
Name:EVANS, SANDRA KAY
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:KAY
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 1:4941 SE 134TH DR
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97236-3976
Mailing Address - Country:US
Mailing Address - Phone:503-761-2429
Mailing Address - Fax:
Practice Address - Street 1:5417 NE 25TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97211-6211
Practice Address - Country:US
Practice Address - Phone:503-402-8118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion