Provider Demographics
NPI:1871650580
Name:EVERIDGE, BETH A
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:A
Last Name:EVERIDGE
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 1:4020 SHOT POUCH ROAD
Mailing Address - Street 2:
Mailing Address - City:BLODGETT
Mailing Address - State:OR
Mailing Address - Zip Code:97326
Mailing Address - Country:US
Mailing Address - Phone:541-453-4112
Mailing Address - Fax:
Practice Address - Street 1:36 SW NYE ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365-3821
Practice Address - Country:US
Practice Address - Phone:541-265-6611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator