Organization
EVERGREEN NATIONAL RESOURCES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KASEY MARIE NELSON (CEO)
(941) 484-9102
Entity
Organization
Contact information
Practice address
621 LIVE OAK ST, VENICE, FL 34285-4732
(941) 484-9102
Mailing address
621 LIVE OAK STREET, VENICE, FL 34285
(941) 484-9102
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
—
—
Other
Enumeration date
02/06/2015
Last updated
02/06/2015
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