Provider Demographics
NPI:1184935801
Name:EVERSON, LAMBERT HAROLD (CNA)
Entity type:Individual
Prefix:
First Name:LAMBERT
Middle Name:HAROLD
Last Name:EVERSON
Suffix:
Gender:M
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1144 13TH ST
Mailing Address - Street 2:
Mailing Address - City:HOLLY HILL
Mailing Address - State:FL
Mailing Address - Zip Code:32117-1902
Mailing Address - Country:US
Mailing Address - Phone:386-682-5798
Mailing Address - Fax:
Practice Address - Street 1:1144 13TH ST
Practice Address - Street 2:
Practice Address - City:HOLLY HILL
Practice Address - State:FL
Practice Address - Zip Code:32117-1902
Practice Address - Country:US
Practice Address - Phone:386-682-5798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-28
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCNA 217770376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide