Active NPI
Jacqueline Ann Everts
- Dental Hygienist
- Waupaca, WI
National Provider Identifier
1023893005
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Hygienist
- License
- 5339-016
- Practice address
- E897 Tammy TRL
Waupaca, WI 54981-8008 - Phone
- (920) 810-0561
- NPI assigned
- Aug 29, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | 5339-016 | WI | Primary |
Addresses
Primary practice location
E897 Tammy TRL
Waupaca, WI 54981-8008
Mailing address
E897 Tammy TRL
Waupaca, WI 54981-8008
Phone (920) 810-0561
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5339-016 | WI | MD | Dental Hygienist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1693267200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1693267200000",
"number": "1023893005",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "E897 TAMMY TRL",
"city": "WAUPACA",
"state": "WI",
"postal_code": "549818008",
"telephone_number": "920-810-0561"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "E897 TAMMY TRL",
"city": "WAUPACA",
"state": "WI",
"postal_code": "549818008",
"telephone_number": "920-810-0561"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EVERTS",
"first_name": "JACQUELINE",
"middle_name": "ANN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-08-29",
"last_updated": "2023-08-29",
"certification_date": "2023-08-29",
"status": "A"
},
"taxonomies": [
{
"code": "124Q00000X",
"taxonomy_group": "",
"desc": "Dental Hygienist",
"state": "WI",
"license": "5339-016",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waupaca, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.