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NPI Code Detail

MEDICARE: ASHLEY EVERSON LSW

MEDICARE:   ASHLEY  EVERSON  LSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial Worker4447ND

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1669793352
Entity Type Code : Individual
Provider Name (Legal Business Name) : ASHLEY EVERSON LSW
Provider Business Mailing Address
First Line : 1820 WALNUT ST E STE 5
Second Line :
City : DEVILS LAKE
State : ND
Zip : 58301-3411
Country : US
Telephone Number : 701-662-4913
Fax Number : 701-662-4963
Provider Business Practice Location Address
First Line : 1820 WALNUT ST E STE 5
Second Line :
City : DEVILS LAKE
State : ND
Zip : 58301-3411
Country : US
Telephone Number : 701-662-4913
Fax Number : 701-662-4963
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2010
Last Update Date : 11/02/2017

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