| NPI | 1902526437 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JANAYA JEAN MARIE EVENSON Member 612-220-3441 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2022-09-02 |
| Last Update Date | 2023-04-12 |