Individual
JERRY WAYNE EVERSOLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
338 E LAGRANGE RD, HANOVER, IN 47243-9618
(812) 273-4640
(812) 273-2925
Mailing address
950 CROSS AVE, MADISON, IN 47250-2002
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
27065312A
IN
Other
Enumeration date
12/01/2022
Last updated
12/01/2022
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