Provider Demographics
NPI:1366912230
Name:GLOVER, EVAN ALEXANDRA (PA-C)
Entity type:Individual
Prefix:MS
First Name:EVAN
Middle Name:ALEXANDRA
Last Name:GLOVER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17507 W 61ST LN
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80403-7456
Mailing Address - Country:US
Mailing Address - Phone:207-218-7333
Mailing Address - Fax:
Practice Address - Street 1:1435 GARRISON ST STE 110
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80215-4748
Practice Address - Country:US
Practice Address - Phone:720-241-3765
Practice Address - Fax:720-310-7216
Is Sole Proprietor?:No
Enumeration Date:2018-12-04
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5650363A00000X
363A00000X
COPA.0005650363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant