Provider Demographics
NPI:1649292897
Name:EVANS, SHAUN (CRNA)
Entity type:Individual
Prefix:
First Name:SHAUN
Middle Name:
Last Name:EVANS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:926 ARROWHEAD TRAIL RD
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84660-9240
Mailing Address - Country:US
Mailing Address - Phone:801-794-9937
Mailing Address - Fax:
Practice Address - Street 1:1000 E 100 N
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:UT
Practice Address - Zip Code:84651-1600
Practice Address - Country:US
Practice Address - Phone:800-748-4868
Practice Address - Fax:801-733-5872
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT201863-4406367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT107027461102OtherIHC
UT23201OtherHEALTHY U
NC8053049Medicaid
UT190382600OtherUS DEPT OF LABOR
UT8401401924SHEOtherEDUCATORS MUTUAL
UTQM0000073445OtherALTIUS
UTQM0000076595OtherALTIUS
UT107027461101OtherIHC
UT820936OtherDESERET MUTUAL
UT270041325SSEOtherEDUCATORS MUTUAL
UTQM0000076612OtherALTIUS
UTTPRA08324OtherMOLINA
UT841401924OtherPHCS
NC8053049Medicaid
UT8401401924SHEOtherEDUCATORS MUTUAL
UT107027461102OtherIHC
UT820936OtherDESERET MUTUAL
UTP0005986Medicare ID - Type UnspecifiedRAILROAD MEDICARE