Healthcare Provider Details

I. General information

NPI: 1639322514
Provider Name (Legal Business Name): JOAN EVERSON APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2008
Last Update Date: 10/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

284 BROADWAY
NEWARK NJ
07104-4003
US

IV. Provider business mailing address

151 PROSPECT AVE APT 14A
HACKENSACK NJ
07601-2209
US

V. Phone/Fax

Practice location:
  • Phone: 973-482-5575
  • Fax: 973-854-3630
Mailing address:
  • Phone: 201-370-4326
  • Fax: 973-278-2344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number26NN05872700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: