Provider Demographics
NPI:1518646819
Name:EVERHART, ELENA
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:
Last Name:EVERHART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 CHESTNUT CT
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-1505
Mailing Address - Country:US
Mailing Address - Phone:815-412-5507
Mailing Address - Fax:
Practice Address - Street 1:10300 VILLAGE CIRCLE DR
Practice Address - Street 2:
Practice Address - City:PALOS PARK
Practice Address - State:IL
Practice Address - Zip Code:60464-3541
Practice Address - Country:US
Practice Address - Phone:708-361-3683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program