Provider Demographics
NPI:1093030843
Name:IVETA EVERINGHAM RNFA SURGICAL ASSISTING SERVICES
Entity Type:Organization
Organization Name:IVETA EVERINGHAM RNFA SURGICAL ASSISTING SERVICES
Other - Org Name:SURGICAL ASSISTING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:IVETA
Authorized Official - Middle Name:
Authorized Official - Last Name:EVERINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:RNFA
Authorized Official - Phone:206-427-2898
Mailing Address - Street 1:P.O. BOX 2847
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-0130
Mailing Address - Country:US
Mailing Address - Phone:206-427-2898
Mailing Address - Fax:541-749-2283
Practice Address - Street 1:1945 16TH LANE NE
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98029
Practice Address - Country:US
Practice Address - Phone:206-427-2898
Practice Address - Fax:541-749-2283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-05
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00144475163WR0006X
OR200740612RN251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First AssistantGroup - Multi-Specialty
No251J00000XAgenciesNursing CareGroup - Multi-Specialty