DERIK SCOTT EVENSON (NPI# 1295910651) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1295910651 |
| Entity Type | Individual |
| Full Name | DERIK SCOTT EVENSON |
| Other Name | DERIK SCOTT EVENSON |
| Credential | NURSE PRACTITIONER |
| Practice Address |
1985 Gratiot Blvd Marysville MI 48040-2215 |
| Practice Telephone | (810) 216-1200 |
| Practice Fax Number | 8102161610 |
| Mailing Telephone | (810) 216-1200 |
| Mailing Fax Number | 8102161610 |
| Enumeration Date | 2008-01-04 |
| Last Update Date | 2018-03-17 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LG0600X |
Nurse Practitioner Specialization: Gerontology |
4704213248 | MI | Physician Assistants & Advanced Practice Nursing Providers |
| N | 367500000X | Nurse Anesthetist, Certified Registered | 4704213248 | MI | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | 1295910651 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1221 Pine Grove Ave, Port Huron, MI 480603511 | 8109875000 | 8109852633 |
| Street Address |
1985 GRATIOT BLVD |
| City | MARYSVILLE |
| State | MI |
| Zip Code | 48040-2215 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740275981 | James Sterling Cabeen | Family Medicine | 1985 Gratiot Blvd, Ste 2a, Marysville, MI 48040-2215 | 2005-09-14 |
| 1861002131 | Port Huron Bone and Joint Surgery PC | Orthopaedic Surgery | 1985 Gratiot Blvd, Marysville, MI 48040-2215 | 2020-08-03 |
| 1972899680 | Arunthathi Tabitha Stallwood | Internal Medicine | 1985 Gratiot Blvd, Marysville, MI 48040-2215 | 2011-06-21 |
| 1497065635 | Laural K Wagley | Nurse Practitioner | 1985 Gratiot Blvd, Marysville, MI 48040-2215 | 2010-10-20 |
| 1073841011 | Tynise La'shaie Penn | Nurse Practitioner | 1985 Gratiot Blvd, Suite 2a, Marysville, MI 48040-2215 | 2009-12-03 |
| 1023297967 | Rigel Galera | Family Medicine | 1985 Gratiot Blvd, Suite 2a, Marysville, MI 48040-2215 | 2007-10-28 |
| 1184702375 | Florello Itchon | Family Medicine | 1985 Gratiot Blvd, Suite 2a, Marysville, MI 48040-2215 | 2006-11-02 |
| 1518917491 | Amgad Nashed-awad | Family Medicine | 1985 Gratiot Blvd, Suite 2a, Marysville, MI 48040-2215 | 2006-05-11 |
| 1790750685 | Mary Cracium | Family Medicine | 1985 Gratiot Blvd, Suite 2a, Marysville, MI 48040-2215 | 2006-02-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902106032 | Sheila Washington | Technician | 1600 Gratiot, Marysville, MI 48040 | 2010-10-22 |
| 1861522666 | Kriste Charlene Hollenbaugh | Pharmacist | 1750 Gratiot Blvd, Marysville, MI 48040 | 2007-03-07 |
| 1083760169 | Patrick August Deview | Optometrist | 3160 Gratiot, Marysville, MI 48040 | 2007-01-25 |
| 1346305133 | Meijer Inc | Durable Medical Equipment & Medical Supplies | 205 S Range Rd, Marysville, MI 48040 | 2006-12-22 |
| 1225143514 | City of Marysville | Ambulance | 1355 Delaware Avenue, Marysville, MI 48040 | 2006-08-20 |
| 1033603063 | Usv Optical Inc. | Eyewear Supplier (Equipment, not the service) | 205 S Range Rd, Marysville, MI 48040 | 2018-06-22 |
| 1154449635 | Brenda Carolyn Hayden | Pharmacist | 1750 Gratiot Blvd, Marysville, MI 48040 | 2007-03-26 |
| 1235696956 | Lisa Curtis | Licensed Practical Nurse | 35 Carolina, Marysville, MI 48040-1011 | 2019-02-28 |
| 1447268529 | Karlene S. Harbour | Social Worker | 501 Gratiot Blvd, Suite 4, Marysville, MI 48040-1124 | 2006-08-04 |
| 1316020688 | Ks Harbour Consulting | Community/Behavioral Health | 501 Gratiot Blvd, Suite 4, Marysville, MI 48040-1124 | 2006-10-23 |
| Find all providers in zip 48040 | ||||
| Taxonomy Code | 363LG0600X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Gerontology |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760871933 | Catherine Rae Vance | Nurse Practitioner | 3350 Gratiot Blvd, Marysville, MI 48040-2121 | 2015-01-12 |
| 1881030419 | Yuba Sutter Hospitalist Group | Nurse Practitioner | 726 4th St, Marysville, CA 95901-5656 | 2013-05-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942800768 | Yuri L Guzman | Nurse Practitioner | 795 N Ford Blvd, Ypsilanti, MI 48198-4116 | 2020-10-30 |
| 1144830803 | Robert Eugene Scribner IIi | Nurse Practitioner | 13913 Toepfer Rd, Warren, MI 48089-5842 | 2020-08-06 |
| 1124644661 | Denika Leflora Dalton | Nurse Practitioner | 5260 Fairway Trl, Grand Blanc, MI 48439-9445 | 2020-06-21 |
| 1780206995 | Jennifer Kay Marino | Nurse Practitioner | 20407 Mauer St, Saint Clair Shores, MI 48080-3789 | 2020-05-11 |
| 1720621709 | Kelsey Nicole Kloosterman | Nurse Practitioner | Susan P. Wheatlake Regional Cancer Center, 4499 220th Ave, Reed City, MI 49677 | 2019-10-23 |
| 1558911842 | Jomy Jose | Nurse Practitioner | 25719 Salem St, Roseville, MI 48066 | 2019-09-18 |
| 1306318498 | Ashley Marie Jacobson | Nurse Practitioner | 4100 Lake Dr Se Ste D, Grand Rapids, MI 49546-8292 | 2018-12-30 |
| 1568931673 | Jennifer Lavigne | Nurse Practitioner | 145 Michigan St Ne Ste 3300, Grand Rapids, MI 49503-2562 | 2018-11-19 |
| 1134694292 | Sheryl Ann Newton | Nurse Practitioner | 810 W South St, Kalamazoo, MI 49007-4601 | 2018-10-04 |
| 1386123180 | Alison M Sesock | Nurse Practitioner | 5202 Miller Rd Ste B, Flint, MI 48507-1040 | 2018-08-13 |
| Find all providers with the same taxonomy | ||||
| City | MARYSVILLE |
| Zip Code | 48040 |
Please comment or provide details below to improve the information on DERIK SCOTT EVENSON.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.