Evans, Russell L

Evans, Russell L is an individual health care provider with primary practice located at 320 Warner Dr , Lewiston ID 83501-4441. He recently has 4 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Vascular & Interventional Radiology, Technologists, Technicians & Other Technical Service Providers / Computed Tomography, Technologists, Technicians & Other Technical Service Providers / Radiography, Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant. Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant is his primary health care specialty. Evans, Russell L can be contacted via phone (208) 743-3523.

Contact Information

Primary practice address
320 Warner Dr Lewiston ID 83501-4441
Phone: (208) 743-3523
Fax: (208) 746-8741
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Vascular & Interventional Radiology 2085R0204X 1851871172 Idaho
Technologists, Technicians & Other Technical Service Providers / Computed Tomography 2471C3401X 408447 Minnesota
Technologists, Technicians & Other Technical Service Providers / Radiography 2471C3402X 408447 Minnesota
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA61007077 Washington
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA-1823 Idaho

Profile Details

NPI number 1851871172
LBN Legal business name Evans, Russell L
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 16th, 2018
Last updated Jun 3rd, 2020 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1851871172 NPPES
Washington MEDICAID 1851871172
Washington MEDICAID 1851871172

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