Healthcare Provider Details

I. General information

NPI: 1396640322
Provider Name (Legal Business Name): EVRBRANCH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1439 ARCADE ST STE 220
SAINT PAUL MN
55106-1829
US

IV. Provider business mailing address

6140 LAMAR AVE S
COTTAGE GROVE MN
55016-1660
US

V. Phone/Fax

Practice location:
  • Phone: 651-377-1166
  • Fax: 651-377-2409
Mailing address:
  • Phone: 651-377-1166
  • Fax: 651-377-2409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number StateNULL

VIII. Authorized Official

Name: NEUCHEE CHANG
Title or Position: LEAD EMPLOYEE
Credential:
Phone: 651-377-1159