Provider Demographics
NPI:1780718924
Name:EVANS, LORI L (CNM)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:L
Last Name:EVANS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 W 10TH AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-6302
Mailing Address - Country:US
Mailing Address - Phone:509-221-5910
Mailing Address - Fax:
Practice Address - Street 1:320 W 10TH AVE STE 102
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-6302
Practice Address - Country:US
Practice Address - Phone:509-221-5910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209005270367A00000X
WAAP60525667367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL3270203Medicare PIN
IL6447860011Medicare NSC
IL208905151Medicare PIN
IL208905151Medicare PIN