Provider Demographics
NPI:1366598062
Name:MCEVERS, JULIE ANN (NP)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:MCEVERS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 BROOKMOOR LN
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-5224
Mailing Address - Country:US
Mailing Address - Phone:269-808-3390
Mailing Address - Fax:
Practice Address - Street 1:1721 MOON LAKE BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-1069
Practice Address - Country:US
Practice Address - Phone:773-360-7721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704105653363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health