Provider Demographics
NPI:1811196918
Name:EVERT, CHRISTIAN RENEE (LPN)
Entity type:Individual
Prefix:MISS
First Name:CHRISTIAN
Middle Name:RENEE
Last Name:EVERT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:CHRISTIAN
Other - Middle Name:RENEE
Other - Last Name:EVERT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:130 MAIN ST APT 1
Mailing Address - Street 2:
Mailing Address - City:LEICESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14481-9998
Mailing Address - Country:US
Mailing Address - Phone:585-943-1552
Mailing Address - Fax:
Practice Address - Street 1:130 MAIN ST APT 1
Practice Address - Street 2:
Practice Address - City:LEICESTER
Practice Address - State:NY
Practice Address - Zip Code:14481-9998
Practice Address - Country:US
Practice Address - Phone:585-943-1552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2768441164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02656348Medicaid