Provider Demographics
NPI:1366555930
Name:EVANS, PAMELA DENISE (DIRECTOR)
Entity type:Individual
Prefix:MISS
First Name:PAMELA
Middle Name:DENISE
Last Name:EVANS
Suffix:
Gender:F
Credentials:DIRECTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:726 E MICHIGAN DR
Mailing Address - Street 2:P O BOX 6044
Mailing Address - City:HOBBS
Mailing Address - State:NM
Mailing Address - Zip Code:88240-3467
Mailing Address - Country:US
Mailing Address - Phone:575-397-2801
Mailing Address - Fax:575-393-4132
Practice Address - Street 1:726 E MICHIGAN DR STE 530
Practice Address - Street 2:
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-3467
Practice Address - Country:US
Practice Address - Phone:505-397-2801
Practice Address - Fax:505-393-4132
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2013-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes177F00000XOther Service ProvidersLodging
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM21473889Medicaid
NM00000J0175Medicaid
NM62225715Medicaid
NM00000D0717Medicaid