Bert Dewayne Evans, LVN

Primary specialty

Licensed Vocational NurseTaxonomy code 164X00000X

License

170451 Issued in CA

Practice address

22576 South Rd
Apple Valley, CA 92307-1933

Phone

(619) 565-8348

NPI assigned

Mar 20, 2009

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1237507200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1237507200000",
    "number": "1346481330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22576 SOUTH RD",
            "city": "APPLE VALLEY",
            "state": "CA",
            "postal_code": "923071933",
            "telephone_number": "619-565-8348"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22576 SOUTH RD",
            "city": "APPLE VALLEY",
            "state": "CA",
            "postal_code": "923071933",
            "telephone_number": "619-565-8348"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EVANS",
        "first_name": "BERT",
        "middle_name": "DEWAYNE",
        "credential": "LVN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-03-20",
        "last_updated": "2009-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164X00000X",
            "taxonomy_group": "",
            "desc": "Licensed Vocational Nurse",
            "state": "CA",
            "license": "170451",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Philip Tanner Etchells, OD
• Daniela Eugenio, COTA/L
• Raquel Eusebio, RN
• Zachery Eustance, PT, DPT
• Michael M Evangelista, PHARM.D.
• David K Evans, DC
• George Edward Evashwick
• Excel Imaging
• Express Walk-in Clinic
• Faculty Physicians and Surgeons of Llusm

• Licensed Vocational Nurse in Apple Valley, CA
• Providers in Apple Valley, CA by specialty
• Licensed Vocational Nurse in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.