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General NPI Number Information
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NPI Number | 1639322514
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Entity Type | Individual
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Provider Name | JOAN EVERSON APN
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Gender | Female
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Dates
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Enumeration Date | 10/23/2008
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Last Update Date | 10/23/2008
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Provider Practice Location Address
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Address Line | 284 BROADWAY
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City | NEWARK
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State | NJ
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Zip | 07104-4003
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Country | US
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Telephone | 973-482-5575
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Fax | 973-854-3630
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Provider Business Mailing Address
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Address Line | 151 PROSPECT AVE APT 14A
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City | HACKENSACK
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State | NJ
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Zip | 07601-2209
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Country | US
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Telephone | 201-370-4326
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Fax | 973-278-2344
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WP0200X
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Taxonomy Name | Pediatric Registered Nurse
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License Number | 26NN05872700
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License Number State | NJ
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