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General NPI Number Information
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NPI Number | 1093030843
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Entity Type | Organization
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Legal Business Name | IVETA EVERINGHAM RNFA SURGICAL ASSISTING SERVICES
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Dates
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Enumeration Date | 04/05/2010
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Last Update Date | 01/27/2021
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Provider Practice Location Address
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Address Line | 1945 16TH LANE NE
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City | ISSAQUAH
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State | WA
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Zip | 98029
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Country | US
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Telephone | 206-427-2898
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Fax | 541-749-2283
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Provider Business Mailing Address
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Address Line | P.O. BOX 2847
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City | ISSAQUAH
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State | WA
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Zip | 98027-0130
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Country | US
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Telephone | 206-427-2898
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Fax | 541-749-2283
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Authorized Official
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Title or Position | OWNER
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Name | MS. IVETA EVERINGHAM
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Credential | RNFA
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Telephone | 206-427-2898
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | 200740612RN
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 163WR0006X
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Taxonomy Name | Registered Nurse First Assistant
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License Number | RN00144475
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License Number State | WA
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