Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 2011011328 | IN |
NPI | 1003182585 |
---|---|
Provider Name | David Lee Evers |
First Address | Dayton, OH 45409-2731 |
Second Address | Dayton, OH 45409-2731 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2012 |
Last Update Date | 08/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0149843 | (05) | OH |