Provider Demographics
NPI:1780926980
Name:EVANS, FREDERICK K JR (CRNA)
Entity type:Individual
Prefix:
First Name:FREDERICK
Middle Name:K
Last Name:EVANS
Suffix:JR
Gender:M
Credentials:CRNA
Other - Prefix:
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Mailing Address - Street 1:3100 SPRING FOREST RD STE 130
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-2880
Mailing Address - Country:US
Mailing Address - Phone:919-882-0705
Mailing Address - Fax:919-873-9821
Practice Address - Street 1:11341 SUNSET HILLS RD
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5205
Practice Address - Country:US
Practice Address - Phone:703-471-0919
Practice Address - Fax:703-472-9081
Is Sole Proprietor?:No
Enumeration Date:2013-03-26
Last Update Date:2015-09-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0024170712367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered