Provider Demographics
NPI:1114562030
Name:EVERETT, ASHLEY (LVN)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:EVERETT
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71175 AURORA RD
Mailing Address - Street 2:
Mailing Address - City:DESERT HOT SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92241-7631
Mailing Address - Country:US
Mailing Address - Phone:760-844-6235
Mailing Address - Fax:
Practice Address - Street 1:71175 AURORA RD
Practice Address - Street 2:
Practice Address - City:DESERT HOT SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92241-7631
Practice Address - Country:US
Practice Address - Phone:760-251-8858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-14
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA696056164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse