Provider Demographics
NPI:1366793556
Name:EVANS, ALLYN ELIZABETH (RD, CSR)
Entity type:Individual
Prefix:MS
First Name:ALLYN
Middle Name:ELIZABETH
Last Name:EVANS
Suffix:
Gender:F
Credentials:RD, CSR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 PARNASSUS AVE
Mailing Address - Street 2:M-294
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-0212
Mailing Address - Country:US
Mailing Address - Phone:415-353-8247
Mailing Address - Fax:415-353-1575
Practice Address - Street 1:505 PARNASSUS AVE
Practice Address - Street 2:M-294
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-0212
Practice Address - Country:US
Practice Address - Phone:415-353-8247
Practice Address - Fax:415-353-1575
Is Sole Proprietor?:No
Enumeration Date:2012-09-27
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA988185133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered