Healthcare Provider Details

I. General information

NPI: 1689099475
Provider Name (Legal Business Name): HOLLY N EVERTS APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2014
Last Update Date: 12/06/2021
Certification Date: 12/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 W KINNICKINNIC RIVER PKWY STE 777
MILWAUKEE WI
53215-3678
US

IV. Provider business mailing address

2801 W. KINNICKINNIC RIVER PKWY. SUITE 777
MILWAUKEE WI
53215
US

V. Phone/Fax

Practice location:
  • Phone: 414-649-3390
  • Fax: 414-649-5769
Mailing address:
  • Phone: 414-649-3390
  • Fax: 414-649-5769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5672
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: