Individual
CASSANDRA EVANETICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1909 MOUNTAIN VIEW LN STE 200, FOREST GROVE, OR 97116-2894
(503) 359-4773
(503) 359-3809
Mailing address
1909 MOUNTAIN VIEW LN STE 200, FOREST GROVE, OR 97116-2894
(503) 359-4773
(503) 359-3809
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
—
—
363AM0700X
Medical Physician Assistant
Primary
PA195867
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500753082
—
OR
Enumeration date
10/08/2019
Last updated
05/04/2021
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