Provider Demographics
NPI:1881727790
Name:EVEREST, THERESA PAOLA (WHNP)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:PAOLA
Last Name:EVEREST
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11010 68TH PL
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-8316
Mailing Address - Country:US
Mailing Address - Phone:847-688-5568
Mailing Address - Fax:
Practice Address - Street 1:1020 11TH AVE
Practice Address - Street 2:NBHC 1523 WOMEN'S HEALTH CLINIC
Practice Address - City:GREAT LAKES
Practice Address - State:IL
Practice Address - Zip Code:60088-3102
Practice Address - Country:US
Practice Address - Phone:847-688-5568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO167717363LW0102X
WARN00114784363LW0102X
OR363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health