Provider Demographics
NPI:1033299821
Name:EVERTZ, LYNN MARIE (LYNN EVERTZ)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:MARIE
Last Name:EVERTZ
Suffix:
Gender:F
Credentials:LYNN EVERTZ
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1277 LANE 10
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:WY
Mailing Address - Zip Code:82435-9323
Mailing Address - Country:US
Mailing Address - Phone:307-754-2323
Mailing Address - Fax:
Practice Address - Street 1:443 W COULTER AVE UNIT 6
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:WY
Practice Address - Zip Code:82435-2643
Practice Address - Country:US
Practice Address - Phone:307-754-2323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY14377163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse