Provider Demographics
NPI:1356883110
Name:EVERLING, MARIANNE
Entity type:Individual
Prefix:
First Name:MARIANNE
Middle Name:
Last Name:EVERLING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 W KING ST
Mailing Address - Street 2:81 WEST KING STREET
Mailing Address - City:BANNING
Mailing Address - State:CA
Mailing Address - Zip Code:92220-2431
Mailing Address - Country:US
Mailing Address - Phone:951-206-4835
Mailing Address - Fax:
Practice Address - Street 1:81 W KING ST
Practice Address - Street 2:81 WEST KING STREET
Practice Address - City:BANNING
Practice Address - State:CA
Practice Address - Zip Code:92220-2431
Practice Address - Country:US
Practice Address - Phone:951-206-4835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-10
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT23889374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician