Healthcare Provider Details

I. General information

NPI: 1831039395
Provider Name (Legal Business Name): EVERGREEN HEALTHCARE CLINIC LIMITED LIABILITY COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 N CHARLES ST STE D
BALTIMORE MD
21201-4305
US

IV. Provider business mailing address

13707 CROWNSGATE WAY
GERMANTOWN MD
20874-4424
US

V. Phone/Fax

Practice location:
  • Phone: 240-644-5570
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: YVETTE LEDJO
Title or Position: OWNER
Credential:
Phone: 240-644-5570