Healthcare Provider Details

I. General information

NPI: 1497828073
Provider Name (Legal Business Name): ADAM GLENN EVERHART R.N., CNOR, RNFA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6867 BERRY BLOSSOM DR
CANFIELD OH
44406-8629
US

IV. Provider business mailing address

6867 BERRY BLOSSOM DR
CANFIELD OH
44406-8629
US

V. Phone/Fax

Practice location:
  • Phone: 330-533-5984
  • Fax:
Mailing address:
  • Phone: 330-533-5984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number190010
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: