Provider Demographics
NPI:1780856468
Name:EVERSOLL, DAVID JONATHAN (RN REGISTERED NURSE)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:JONATHAN
Last Name:EVERSOLL
Suffix:
Gender:M
Credentials:RN REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:776 UNION ST
Mailing Address - Street 2:
Mailing Address - City:PLATTEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53818-2029
Mailing Address - Country:US
Mailing Address - Phone:608-348-5753
Mailing Address - Fax:
Practice Address - Street 1:1516 DEVALERA
Practice Address - Street 2:
Practice Address - City:PLATTEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53818-2029
Practice Address - Country:US
Practice Address - Phone:608-348-5753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38312100Medicaid