1023479425 NPI number — REBECCA JANE EVANS CADC INTERN

Table of content: REBECCA JANE EVANS CADC INTERN (NPI 1023479425)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023479425 NPI number — REBECCA JANE EVANS CADC INTERN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EVANS
Provider First Name:
REBECCA
Provider Middle Name:
JANE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CADC INTERN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCPHERSON
Provider Other First Name:
REBECCA
Provider Other Middle Name:
JANE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1023479425
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/11/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1023 SANTA YNEZ AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HENDERSON
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89002-9012
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-321-9516
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
220 E HORIZON DR
Provider Second Line Business Practice Location Address:
SUITE G
Provider Business Practice Location Address City Name:
HENDERSON
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89015-8035
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-565-5004
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/11/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  01964-I , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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