# RUSSELL L EVANS

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1851871172
- **Gender:** Man
- **Credential:** PA-C

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2085R0204X | Vascular & Interventional Radiology Physician | 1851871172 | ID | — |
| 2471C3401X | Computed Tomography Radiologic Technologist | 408447 | MN | — |
| 2471C3402X | Radiography Radiologic Technologist | 408447 | MN | — |
| 363A00000X | Physician Assistant | PA-1823 | ID | Yes |
| 363A00000X | Physician Assistant | PA61007077 | WA | — |

## Other

- **Enumeration date:** 08/16/2018
- **Last updated:** 06/03/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1851871172 | — | ID |
| 05 | — | 1851871172 | — | WA |