Provider Demographics
NPI:1265617708
Name:EVERSON, ARLYCE O (RN, CCM, NCTMB)
Entity type:Individual
Prefix:
First Name:ARLYCE
Middle Name:O
Last Name:EVERSON
Suffix:
Gender:F
Credentials:RN, CCM, NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 10TH ST S
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-4736
Mailing Address - Country:US
Mailing Address - Phone:608-392-9769
Mailing Address - Fax:608-392-9567
Practice Address - Street 1:630 10TH ST S
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-4736
Practice Address - Country:US
Practice Address - Phone:608-392-9769
Practice Address - Fax:608-392-9567
Is Sole Proprietor?:No
Enumeration Date:2008-01-03
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3023225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist