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NPI Code Detail

MEDICARE: EVONNE BROTEN

MEDICARE: EVONNE BROTEN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1376125179
Entity Type Code : Individual
Provider Name (Legal Business Name) : EVONNE BROTEN
Provider Business Mailing Address
First Line : 4844 BLOOMINGTON AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55417-1136
Country : US
Telephone Number : 612-642-1114
Fax Number :
Provider Business Practice Location Address
First Line : 4844 BLOOMINGTON AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55417-1136
Country : US
Telephone Number : 612-642-1114
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/22/2021
Last Update Date : 04/22/2021

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Directions to “ EVONNE BROTEN ” Practice Location

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