Provider Demographics
NPI:1881970101
Name:EVERING-PATRICK, SUERETTE JONI-MARIE (RN)
Entity type:Individual
Prefix:
First Name:SUERETTE
Middle Name:JONI-MARIE
Last Name:EVERING-PATRICK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 SHIRING LN
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-3209
Mailing Address - Country:US
Mailing Address - Phone:203-596-1259
Mailing Address - Fax:
Practice Address - Street 1:500 LINDA AVE
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:NY
Practice Address - Zip Code:10532-1313
Practice Address - Country:US
Practice Address - Phone:914-773-6790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-01
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY549779163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse