Healthcare Provider Details

I. General information

NPI: 1346554037
Provider Name (Legal Business Name): ERICKA JAYLENE EVERLY CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2010
Last Update Date: 05/08/2024
Certification Date: 05/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 13TH ST
HAVRE MT
59501-5222
US

IV. Provider business mailing address

PO BOX 1231
HAVRE MT
59501-1231
US

V. Phone/Fax

Practice location:
  • Phone: 406-262-1419
  • Fax: 406-265-1651
Mailing address:
  • Phone: 406-262-1302
  • Fax: 406-265-1651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number201998
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: