Provider Demographics
NPI:1962195206
Name:EVOLVE HEALTH NV CARTER PLLC
Entity type:Organization
Organization Name:EVOLVE HEALTH NV CARTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:A
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:971-358-9292
Mailing Address - Street 1:6400 SE LAKE RD STE 430
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97222-2129
Mailing Address - Country:US
Mailing Address - Phone:971-358-9292
Mailing Address - Fax:503-917-4971
Practice Address - Street 1:330 E MILL PLAIN BLVD STE 401
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660-2896
Practice Address - Country:US
Practice Address - Phone:503-447-3285
Practice Address - Fax:503-917-4971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty