Doctor Name: | EVANS KOMEN |
NPI Number: | 1003216839 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | DNP,PMHNP-BC |
License Number: | G119281 |
Business Practice Address: | 2750 Saint Francis Dr Waterloo, IA - 507025644 |
Business Phone Number: | 3192728922 |
Business Fax Number: | 3192728929 |
Mailing Address: | 2750 Saint Francis Dr, WATERLOO |
State: | IA |
Postal Code: | 507025644 |
Phone Number: | 3192728922 |
Fax Number: | 3192728929 |
NPI Enumeration Date: | 08/29/2014 |
NPI Last Update Date: | 08/29/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LP0808X |
License Number: | G119281 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Psych/Mental Health |
Taxonomy Definition: |