Provider Demographics
NPI:1124210554
Name:EVERS, SUSAN EDITH (PA)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:EDITH
Last Name:EVERS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:EDITH
Other - Middle Name:LYDIA
Other - Last Name:EVERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:305 EAST MAIN STREET
Mailing Address - Street 2:ALBEMARLE MENTAL HEALTH CENTER P.O. BOX 2367
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27906-2367
Mailing Address - Country:US
Mailing Address - Phone:252-335-0803
Mailing Address - Fax:252-335-9143
Practice Address - Street 1:210 W LIBERTY ST
Practice Address - Street 2:ALBEMARLE MENTAL HEALTH CENTER
Practice Address - City:WILLIAMSTON
Practice Address - State:NC
Practice Address - Zip Code:27892-1712
Practice Address - Country:US
Practice Address - Phone:252-792-5151
Practice Address - Fax:252-792-0802
Is Sole Proprietor?:No
Enumeration Date:2007-08-09
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103567363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP86955Medicare UPIN