Provider Demographics
NPI:1295130599
Name:EVERHART, VIRGINIA MARIE
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:MARIE
Last Name:EVERHART
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:VIRGINIA
Other - Middle Name:
Other - Last Name:EVERHART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1016
Mailing Address - Street 2:
Mailing Address - City:COSHOCTON
Mailing Address - State:OH
Mailing Address - Zip Code:43812-5016
Mailing Address - Country:US
Mailing Address - Phone:740-575-5364
Mailing Address - Fax:
Practice Address - Street 1:733 POPLAR ST APT B
Practice Address - Street 2:
Practice Address - City:COSHOCTON
Practice Address - State:OH
Practice Address - Zip Code:43812-2188
Practice Address - Country:US
Practice Address - Phone:740-575-5364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-29
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0097683Medicaid