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Individual

LACEY EVANS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
APRN

Contact information

Practice address
12636 SE STARK ST BLDG J, PORTLAND, OR 97233-1058
(503) 233-4600
Mailing address
12636 SE STARK ST BLDG J, PORTLAND, OR 97233-1058
(503) 253-4600

Taxonomy

Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
201808357RN
OR
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
202202396NP-PP
OR
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
AP61275118
WA

Other

Enumeration date
02/26/2019
Last updated
01/25/2024
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