Healthcare Provider Details

I. General information

NPI: 1124922406
Provider Name (Legal Business Name): UPSIDIAN CARE NETWORK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1128 HARMON PL STE 200
MINNEAPOLIS MN
55403-2074
US

IV. Provider business mailing address

200 UNIVERSITY AVE SE UNIT 2403
MINNEAPOLIS MN
55414-2475
US

V. Phone/Fax

Practice location:
  • Phone: 612-552-3066
  • Fax:
Mailing address:
  • Phone: 612-552-3066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. YANEVE FONGE
Title or Position: FOUNDER AND CEO
Credential: MD
Phone: 203-668-9057