Healthcare Provider Details

I. General information

NPI: 1104775345
Provider Name (Legal Business Name): NATHAN DALE EVERSON PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

916 4TH AVE SW
PIPESTONE MN
56164-1890
US

IV. Provider business mailing address

916 4TH AVE SW
PIPESTONE MN
56164-1890
US

V. Phone/Fax

Practice location:
  • Phone: 507-825-5700
  • Fax: 507-825-4706
Mailing address:
  • Phone: 507-825-5700
  • Fax: 507-825-4762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number15871
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: