Provider Demographics
NPI:1487628327
Name:EVANS, STEPHANIE MICHELLE (PAC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:MICHELLE
Last Name:EVANS
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2230 S FRASER ST
Mailing Address - Street 2:UNIT 1
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-4535
Mailing Address - Country:US
Mailing Address - Phone:303-341-4200
Mailing Address - Fax:303-341-4480
Practice Address - Street 1:2230 S FRASER ST
Practice Address - Street 2:UNIT 1
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-4535
Practice Address - Country:US
Practice Address - Phone:303-341-4200
Practice Address - Fax:303-341-4480
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1262363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
466268Medicare ID - Type Unspecified
P60226Medicare UPIN