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General NPI Number Information
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NPI Number | 1053116483
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Entity Type | Organization
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Legal Business Name | EVERNORTH CLINIC, PLLC
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Dates
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Enumeration Date | 02/18/2025
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Last Update Date | 10/06/2025
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Provider Practice Location Address
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Address Line | 5703 LACHMAN AVE NE
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City | ALBERTVILLE
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State | MN
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Zip | 55301-3973
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Country | US
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Telephone | 763-284-1877
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Fax | 763-205-5834
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Provider Business Mailing Address
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Address Line | PO BOX 48
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City | ALBERTVILLE
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State | MN
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Zip | 55301-0048
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Country | US
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Telephone | 763-284-1877
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Fax | 763-205-5834
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Authorized Official
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Title or Position | OWNER, FOUNDER
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Name | AMANDA JOHNSON
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Credential | APRN, CPNP-PC
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Telephone | 931-436-8197
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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