Provider Demographics
NPI:1821464835
Name:EVERHART, ANNE MICHELLE GUNGON (MSN, FNP-C)
Entity Type:Individual
Prefix:
First Name:ANNE MICHELLE
Middle Name:GUNGON
Last Name:EVERHART
Suffix:
Gender:F
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:ANNE MICHELLE
Other - Middle Name:CALE
Other - Last Name:GUNGON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 LIBERTY PLZ STE 301
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10006-1404
Mailing Address - Country:US
Mailing Address - Phone:917-261-4414
Mailing Address - Fax:
Practice Address - Street 1:530 5TH AVE FL 10
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-5114
Practice Address - Country:US
Practice Address - Phone:917-261-4414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-12
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA708722163W00000X
IL041491781163W00000X
MARN2364335163W00000X, 363LP2300X
NY763343163W00000X, 363LP2300X
CA95002876363LP2300X
IL209021097363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse