Healthcare Provider Details

I. General information

NPI: 1154529253
Provider Name (Legal Business Name): VICKI B EVENSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2007
Last Update Date: 07/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N3150 HWY 81
MONROE WI
53566
US

IV. Provider business mailing address

N3150 HWY 81
MONROE WI
53566
US

V. Phone/Fax

Practice location:
  • Phone: 608-328-9390
  • Fax: 608-325-7575
Mailing address:
  • Phone: 608-328-9390
  • Fax: 608-325-7575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number53307
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: