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Individual

MRS. LOANA EDITH EVANS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
N.P. - C

Contact information

Practice address
2115 S FREMONT AVE, SUITE 4300, SPRINGFIELD, MO 65804-2239
(417) 820-3911
(417) 820-3924
Mailing address
2115 S FREMONT AVE, SUITE 4300, SPRINGFIELD, MO 65804-2239
(417) 820-3911
(417) 820-3924

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
RN072421
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1184715484
MO
05
176559758
AR
01
2221
BLUE SHIELD
05
242641702
MO
01
431560263
TRICARE WEST
01
P00709666
RAILROAD MEDICARE
Enumeration date
09/28/2006
Last updated
07/13/2009
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