Individual
GABRIEL T EVENSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MOTRL
Contact information
Practice address
3321 4TH AVE. S, SUITE D, FARGO, ND 58103
(701) 200-8181
(701) 365-8585
Mailing address
4425 47TH ST. S, FARGO, ND 58104
(701) 200-8181
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
995
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
27813
BLUE CROSS BLUE SHIELD OF
ND
Enumeration date
02/28/2007
Last updated
07/18/2007
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