Healthcare Provider Details

I. General information

NPI: 1780952739
Provider Name (Legal Business Name): EUNICE A ADETONA PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2011
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 THOMPSON AVE E
WEST ST PAUL MN
55118-3241
US

IV. Provider business mailing address

430 THOMPSON AVE E
WEST ST PAUL MN
55118-3241
US

V. Phone/Fax

Practice location:
  • Phone: 608-206-5318
  • Fax:
Mailing address:
  • Phone: 608-206-5318
  • Fax: 608-206-5318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number165598-30
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: