Organization
EVERNORTH CARE PROVIDERS - DELAWARE PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GRACE V BLUE (CREDENTIALING SR. MANAGER)
(773) 292-4800
Entity
Organization
Contact information
Practice address
67 MERCHANTS ROW STE 201, RUTLAND, VT 05701-5938
(773) 292-4800
(312) 564-4059
Mailing address
730 COOL SPRINGS BLVD STE 500, FRANKLIN, TN 37067-7331
(773) 292-4800
(312) 564-4059
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207QH0002X
Hospice and Palliative Medicine (Family Medicine) Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
207RH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician
—
—
Other
Enumeration date
05/27/2022
Last updated
02/21/2024
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