Provider Demographics
NPI:1396148367
Name:EVANS, PRISCILLA (ND)
Entity type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 69
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27512-0069
Mailing Address - Country:US
Mailing Address - Phone:919-604-2235
Mailing Address - Fax:
Practice Address - Street 1:401 KEISLER DR
Practice Address - Street 2:SUITE 101
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-7084
Practice Address - Country:US
Practice Address - Phone:919-604-2235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-03
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT00000726175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath