Provider Demographics
NPI:1154529253
Name:EVENSON, VICKI B (RN)
Entity type:Individual
Prefix:MRS
First Name:VICKI
Middle Name:B
Last Name:EVENSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N3150 HWY 81
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WI
Mailing Address - Zip Code:53566
Mailing Address - Country:US
Mailing Address - Phone:608-328-9390
Mailing Address - Fax:608-325-7575
Practice Address - Street 1:N3150 HWY 81
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WI
Practice Address - Zip Code:53566
Practice Address - Country:US
Practice Address - Phone:608-328-9390
Practice Address - Fax:608-325-7575
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI53307163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse