MEDICARE: BARBARA EVERSON RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	199917-30	WI

General Provider Information

NPI Number	:	1760896732
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARBARA EVERSON RN

Provider Business Mailing Address
First Line	:	134 W MADISON AVE
Second Line	:
City	:	GRANTSBURG
State	:	WI
Zip	:	54840-7022
Country	:	US
Telephone Number	:	715-463-5004
Fax Number	:	715-463-5003

Provider Business Practice Location Address
First Line	:	134 W MADISON AVE
Second Line	:
City	:	GRANTSBURG
State	:	WI
Zip	:	54840-7022
Country	:	US
Telephone Number	:	715-463-5004
Fax Number	:	715-463-5003

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2014
Last Update Date	:	06/17/2014

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