Provider Demographics
NPI:1811975139
Name:EVERSON, MAJA MICHELLE (MD)
Entity type:Individual
Prefix:
First Name:MAJA
Middle Name:MICHELLE
Last Name:EVERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 PACIFIC AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98337-1903
Mailing Address - Country:US
Mailing Address - Phone:877-782-1995
Mailing Address - Fax:360-782-1701
Practice Address - Street 1:220 W 11TH ST
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-3944
Practice Address - Country:US
Practice Address - Phone:209-831-5941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN381652084P0800X
AZ436252084P0800X
WAMD610676102084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN60356EVOtherBCBS OF MN
MN1535698OtherMEDICA
MN756523200Medicaid