Individual
IDA KATRINA EVANS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1034 N 500 W, PROVO, UT 84604-3380
(801) 357-7414
Mailing address
PO BOX 27128, SALT LAKE CITY, UT 84127-0128
Taxonomy
Speciality
Code
Description
License number
State
163WN0002X
Neonatal Intensive Care Registered Nurse
324214-3201
UT
363LN0000X
Neonatal Nurse Practitioner
Primary
324214-4405
UT
Other
Enumeration date
03/21/2022
Last updated
12/08/2022
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