Healthcare Provider Details

I. General information

NPI: 1003182585
Provider Name (Legal Business Name): DAVID LEE EVERS ANP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2012
Last Update Date: 02/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 WYOMING ST
DAYTON OH
45409-2731
US

IV. Provider business mailing address

122 WYOMING ST
DAYTON OH
45409-2731
US

V. Phone/Fax

Practice location:
  • Phone: 937-223-4461
  • Fax: 937-449-7603
Mailing address:
  • Phone: 937-223-4461
  • Fax: 937-449-7603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number2011011328
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: