Provider Demographics
NPI:1720412372
Name:EVERTON, CONNIE ELANE (LPN)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:ELANE
Last Name:EVERTON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1930 CONNECTICUT DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-2985
Mailing Address - Country:US
Mailing Address - Phone:970-988-8115
Mailing Address - Fax:
Practice Address - Street 1:1930 CONNECTICUT DR
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-2985
Practice Address - Country:US
Practice Address - Phone:970-988-8115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-29
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO20740164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse