Individual
LISA M. EVANS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1615 DELAWARE ST., LONGVIEW, WA 98632-0302
(360) 414-2385
(360) 414-2386
Mailing address
PO BOX 3002, LONGVIEW, WA 98632
(360) 414-2385
(360) 414-2386
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD00044037
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0201114
LABOR & IND.
WA
05
—
270056
—
OR
05
—
8435851
—
WA
01
—
8913895
CRIME VICTIMS
WA
01
—
P00293336
RR MEDICARE
—
Enumeration date
06/17/2005
Last updated
01/10/2013
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