Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | L5328 | TX |
Y | 2081P2900X | Pain Medicine | L5328 | TX |
NPI | 1154380517 |
---|---|
Provider Name | Mrs. Elizabeth Eversull |
First Address | Boyce, LA 71409-0097 |
Second Address | Plano, TX 75093-6421 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2006 |
Last Update Date | 23/10/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
176702201 | (05) | TX |
H56331 | (02) |