Individual
MARK R EVANS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
855 N WESTHAVEN DR, OSHKOSH, WI 54904-7668
(920) 303-8700
Mailing address
3301 W FOREST HOME AVE, MILWAUKEE, WI 53215-2843
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1052-023
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42986300
—
WI
Enumeration date
07/12/2006
Last updated
12/06/2021
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