Basic Information
Provider Information
NPI: 1518430263
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LAMAR
FirstName: EVE
MiddleName: M
NamePrefix:  
NameSuffix:  
Credential: NP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: WATSON
OtherFirstName: EVE
OtherMiddleName: M
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: PO BOX 1230
Address2:  
City: EVANSVILLE
State: IN
PostalCode: 477061230
CountryCode: US
TelephoneNumber: 8124649133
FaxNumber: 8124640559
Practice Location
Address1: 520 MARY ST STE 230
Address2:  
City: EVANSVILLE
State: IN
PostalCode: 477101678
CountryCode: US
TelephoneNumber: 8124649133
FaxNumber: 8124640559
Other Information
ProviderEnumerationDate: 01/05/2019
LastUpdateDate: 03/14/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363L00000X71008837AINY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

No ID Information.


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