Provider Demographics
NPI:1730617069
Name:EVERSON, JULIE ANN (MSN, NNP-BC)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:EVERSON
Suffix:
Gender:F
Credentials:MSN, NNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VIROQUA
Mailing Address - State:WI
Mailing Address - Zip Code:54665-2059
Mailing Address - Country:US
Mailing Address - Phone:608-637-4769
Mailing Address - Fax:608-638-5042
Practice Address - Street 1:206 N MILL ST
Practice Address - Street 2:
Practice Address - City:LA FARGE
Practice Address - State:WI
Practice Address - Zip Code:54639-6601
Practice Address - Country:US
Practice Address - Phone:608-625-2494
Practice Address - Fax:608-638-5011
Is Sole Proprietor?:No
Enumeration Date:2017-05-31
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8061363LF0000X
MN104332791363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care