Provider Demographics
NPI:1801284211
Name:EVANS, MICHELE DARCY (CNM PHD)
Entity type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:DARCY
Last Name:EVANS
Suffix:
Gender:F
Credentials:CNM PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 N MOORE ST
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843-3255
Mailing Address - Country:US
Mailing Address - Phone:208-310-6373
Mailing Address - Fax:
Practice Address - Street 1:605 N MOORE ST
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-3255
Practice Address - Country:US
Practice Address - Phone:208-310-6373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-07
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDN-20991367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife