Basic Information
| Provider Information | |||||||||
| NPI: | 1942408844 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EVANS | ||||||||
| FirstName: | JEANNIE | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2650 E SHOW LOW LK RD | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | SHOW LOW | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 859017955 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9285374300 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2650 E SHOW LOW LAKE RD | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | SHOW LOW | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 859017955 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9285374300 | ||||||||
| FaxNumber: | 9285374320 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2007 | ||||||||
| LastUpdateDate: | 05/24/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 005387 | AZ | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.