Provider Demographics
NPI:1811965262
Name:EVANS, ELISABETH L (MD)
Entity type:Individual
Prefix:
First Name:ELISABETH
Middle Name:L
Last Name:EVANS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6520 226TH PL SE
Mailing Address - Street 2:STE 120
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027
Mailing Address - Country:US
Mailing Address - Phone:425-391-8886
Mailing Address - Fax:425-394-1087
Practice Address - Street 1:6520 226TH PL SE
Practice Address - Street 2:STE 120
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027
Practice Address - Country:US
Practice Address - Phone:425-391-8886
Practice Address - Fax:425-394-1087
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00024317207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1121136Medicaid
WA2269EVOtherREGENCE BLUE SHIELD
4469535OtherAETNA
WA8850993Medicare ID - Type Unspecified
WA1121136Medicaid