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Contact Information

RUSSELL L EVANS, PA-C
320 WARNER DR
LEWISTON, ID83501-4441
 Phone: 208-743-3523
 Fax: 208-746-8741
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Physician Assistant

363A00000X 97 Physician Assistant
 

Computed Tomography Radiologic Technologist

2471C3401X
 

Radiography Radiologic Technologist

2471C3402X
 

Vascular & Interventional Radiology

2085R0204X 94 Physician/Interventional Radiology
Indicates primary specialty

NPI Profile & details for RUSSELL L EVANS · (Male)

NPI Number 1851871172
Status Active
Credentials PA-C (Physician Assistant-Certified)
Entity Individual
Enumeration date 08/16/2018
Last updated 06/03/2020 - About 6 years ago
Sole proprietor 1 No
Identifiers
  • ID License # 1851871172
  • ID License # PA-1823
  • MN License # 408447
  • WA License # PA61007077
  • ID Medicaid 1851871172
  • WA Medicaid 1851871172
Hospital affiliation(s)
  • ST JOSEPH REGIONAL MEDICAL CENTER - (Acute Care)
    415 SIXTH STREET
    LEWISTON, ID 83501
  • TRI-STATE MEMORIAL HOSPITAL - (Critical Access)
    1221 HIGHLAND AVENUE
    CLARKSTON, WA 99403
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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