=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720409022
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HEATHER EVERETT NP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/04/2014
-----------------------------------------------------
Last Update Date | 08/03/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1320 N MICHIGAN AVE SUITE 7
-----------------------------------------------------
City | SAGINAW
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48602
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-583-7460
-----------------------------------------------------
Fax | 989-583-7432
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1447 N HARRISON ST
-----------------------------------------------------
City | SAGINAW
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48602-4727
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-583-2833
-----------------------------------------------------
Fax | 989-583-1440
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 4704270646
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------