Healthcare Provider Details

I. General information

NPI: 1215669049
Provider Name (Legal Business Name): EVELYN AMANDA YAEGGY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: EVELYN AMANDA HERNANDEZ

II. Dates (important events)

Enumeration Date: 06/29/2022
Last Update Date: 06/29/2022
Certification Date: 06/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1619 DAYTON AVE STE 111
SAINT PAUL MN
55104-6276
US

IV. Provider business mailing address

6221 CAMDEN AVE N
BROOKLYN CENTER MN
55430-2220
US

V. Phone/Fax

Practice location:
  • Phone: 612-518-2140
  • Fax:
Mailing address:
  • Phone: 612-518-2140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175M00000X
TaxonomyLay Midwife
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: