Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 8365A | WY |
N | 207Q00000X | Family Doctor | DOS-1720 | HI |
Y | 207Q00000X | Family Doctor | DR.0060131 | CO |
NPI | 1003071804 |
---|---|
Provider Name | Dr. Shannon D Evans |
First Address | Fort Collins, CO 80525 |
Second Address | Fort Collins, CO 80525 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2008 |
Last Update Date | 22/08/2018 |