Individual
MR. KENNETH EVANGELISTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1321 COLBY AVE, EVERETT, WA 98201-1665
(425) 261-2000
Mailing address
PO BOX 3360, PORTLAND, OR 97208-3360
(866) 747-2455
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
AP60698654
WA
Other
Enumeration date
11/30/2013
Last updated
12/11/2019
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