Individual
DR. AMANDA MARIE EVERHART
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
21260 CHIPPENDALE AVE W, FARMINGTON, MN 55024-1427
(651) 463-7181
(651) 241-0829
Mailing address
2925 CHICAGO AVE, MINNEAPOLIS, MN 55407-1321
(612) 262-5000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
49714
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
145430000
—
MN
01
—
16P75EV
BCBS
MN
01
—
1851513865
MEDICA
—
01
—
P00438360
RR MEDICARE PTAN
—
Enumeration date
05/02/2007
Last updated
11/10/2020
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