Provider Demographics
NPI:1588949101
Name:EVERSON, TRISHA ANN (PA-C)
Entity type:Individual
Prefix:
First Name:TRISHA
Middle Name:ANN
Last Name:EVERSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TRISHA
Other - Middle Name:ANN
Other - Last Name:WEILAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3 NEENAH CTR
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-3070
Mailing Address - Country:US
Mailing Address - Phone:920-380-4999
Mailing Address - Fax:920-380-4916
Practice Address - Street 1:800 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:WAUPACA
Practice Address - State:WI
Practice Address - Zip Code:54981-1943
Practice Address - Country:US
Practice Address - Phone:920-380-4999
Practice Address - Fax:920-380-4961
Is Sole Proprietor?:No
Enumeration Date:2011-10-14
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2868-23363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant