Provider Demographics
NPI:1639322514
Name:EVERSON, JOAN (APN)
Entity type:Individual
Prefix:MS
First Name:JOAN
Middle Name:
Last Name:EVERSON
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 PROSPECT AVE
Mailing Address - Street 2:APT 14A
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-2209
Mailing Address - Country:US
Mailing Address - Phone:201-370-4326
Mailing Address - Fax:973-278-2344
Practice Address - Street 1:284 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07104-4003
Practice Address - Country:US
Practice Address - Phone:973-482-5575
Practice Address - Fax:973-854-3630
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-23
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN05872700163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics