Provider Demographics
NPI:1922256395
Name:EVERINGHAM, IVETA (RNFA)
Entity Type:Individual
Prefix:MRS
First Name:IVETA
Middle Name:
Last Name:EVERINGHAM
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2847
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027
Mailing Address - Country:US
Mailing Address - Phone:206-427-2898
Mailing Address - Fax:541-647-2171
Practice Address - Street 1:1945 16 TH AVE NE
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98029
Practice Address - Country:US
Practice Address - Phone:206-427-2898
Practice Address - Fax:541-647-2171
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-28
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200740612RN163WR0006X, 163WS0121X
WARN00144475163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
No163WS0121XNursing Service ProvidersRegistered NursePlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA275020OtherSURGICAL ASSISTING SERVICES