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:
Health care specialties
| Specialty | Code | License # | 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1851871172 | NPPES |
| Washington | MEDICAID | 1851871172 | |
| Washington | MEDICAID | 1851871172 |
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