Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 415 | CO |
N | 103T00000X | Psychologist | 415 | CO |
Y | 103G00000X | Clinical Psychologist | 415 | CO |
Y | 103TC0700X | Clinical Psychologist | 415 | CO |
NPI | 1013258581 |
---|---|
Provider Name | Dr. Hannah Imogene Evans |
First Address | Paramus, NJ 07652-3508 |
Second Address | Parker, CO 80138-8573 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2013 |
Last Update Date | 05/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PSY.000415 | PROFESSIONAL LICENSE (01) | CO |