Provider Demographics
NPI:1184921322
Name:EVEREST, JULIANE NATASHA (PA-C)
Entity type:Individual
Prefix:MS
First Name:JULIANE
Middle Name:NATASHA
Last Name:EVEREST
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:723 N BEERS ST STE 2C
Mailing Address - Street 2:
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-1512
Mailing Address - Country:US
Mailing Address - Phone:732-888-8255
Mailing Address - Fax:732-888-7682
Practice Address - Street 1:723 N BEERS ST STE 2C
Practice Address - Street 2:
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-1512
Practice Address - Country:US
Practice Address - Phone:723-888-8255
Practice Address - Fax:723-888-7682
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-24
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014523363A00000X
NJ25MP00273600363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant