Provider Demographics
NPI:1447054911
Name:EVANS, ANDIE G (DO)
Entity type:Individual
Prefix:
First Name:ANDIE
Middle Name:G
Last Name:EVANS
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 N SYCAMORE AVE APT 404
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-8896
Mailing Address - Country:US
Mailing Address - Phone:224-489-0455
Mailing Address - Fax:
Practice Address - Street 1:3501 ARROWHEAD DR
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-6056
Practice Address - Country:US
Practice Address - Phone:575-674-2266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program