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Individual

MRS. MARY E EVERSOLE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
FNP

Contact information

Practice address
1100 REID PKWY STE 210, RICHMOND, IN 47374-1157
(765) 962-1337
(765) 966-0858
Mailing address
1100 REID PKWY, MEDICAL STAFF SERVICES, RICHMOND, IN 47374-1157
(765) 983-3492
(765) 983-7958

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71004556A
IN
363LF0000X
Family Nurse Practitioner
COA.17256-NP
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000873886
ANTHEM
IN
05
0102806
OH
05
201219820
IN
Enumeration date
08/14/2013
Last updated
06/28/2024
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