Basic Information
| Provider Information | |||||||||
| NPI: | 1457544249 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OXENFORD | ||||||||
| FirstName: | EVELYN | ||||||||
| MiddleName: | KVERNDAL | ||||||||
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| Credential: | ARNP | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | KVERNDAL | ||||||||
| OtherFirstName: | EVELYN | ||||||||
| OtherMiddleName: | |||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 709 W ORCHARD DR | ||||||||
| Address2: | SUITE 4 | ||||||||
| City: | BELLINGHAM | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982251766 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3603188800 | ||||||||
| FaxNumber: | 3603181085 | ||||||||
| Practice Location | |||||||||
| Address1: | 3015 SQUALICUM PKWY | ||||||||
| Address2: | SUITE 160 | ||||||||
| City: | BELLINGHAM | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982251945 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3606714402 | ||||||||
| FaxNumber: | 3606719463 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2007 | ||||||||
| LastUpdateDate: | 08/10/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | RN00172104 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 9653924 | 05 | WA | MEDICAID | 5797OX | 01 | REGENCE | OTHER | 0237831 | 01 | WA | DEPARTMENT OF LABOR AND INDUSTRIES | OTHER | 5739OX | 01 | WA | REGENCE | OTHER | 8947980 | 01 | WA | L&I CRIME VICTIMS | OTHER |