Provider Demographics
NPI:1811143191
Name:EVENSON, ROBIN LOUISE (RN PHN)
Entity type:Individual
Prefix:MS
First Name:ROBIN
Middle Name:LOUISE
Last Name:EVENSON
Suffix:
Gender:F
Credentials:RN PHN
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:LOUIS
Other - Last Name:EMMERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:529 I ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501
Mailing Address - Country:US
Mailing Address - Phone:707-441-6200
Mailing Address - Fax:707-441-5580
Practice Address - Street 1:529 I ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501
Practice Address - Country:US
Practice Address - Phone:707-441-6200
Practice Address - Fax:707-441-5580
Is Sole Proprietor?:No
Enumeration Date:2008-08-18
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN293814163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse