Healthcare Provider Details

I. General information

NPI: 1164355210
Provider Name (Legal Business Name): NEVAEH PRIEST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10180 VIKING DR
EDEN PRAIRIE MN
55344-7207
US

IV. Provider business mailing address

2426 PONDS WAY
SHAKOPEE MN
55379-4390
US

V. Phone/Fax

Practice location:
  • Phone: 612-509-6680
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: