Basic Information
| Provider Information | |||||||||
| NPI: | 1578589958 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EVANS | ||||||||
| FirstName: | ROSMARY | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1100 HIGHWAY 71 S STE 101 | ||||||||
| Address2: | |||||||||
| City: | HOT SPRINGS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 577478801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6058900055 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1100 HIGHWAY 71 S STE 101 | ||||||||
| Address2: | |||||||||
| City: | HOT SPRINGS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 577478801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6057455188 | ||||||||
| FaxNumber: | 6057453039 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2006 | ||||||||
| LastUpdateDate: | 05/01/2012 | ||||||||
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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 | 363AM0700X | 0292 | SD | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | 0292 | 01 | SD | LICENSE | OTHER | 5307030 | 05 | SD | MEDICAID |