| Ametrine Mental Health Pllc | |
|
194 Progress Way Spicer MN 56288-5000 | |
| (320) 640-2891 | |
| Not Available |
| Full Name | Ametrine Mental Health Pllc |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 194 Progress Way, Spicer, Minnesota |
| Authorized Official Name and Position | Janaya Jean Marie Evenson (MEMBER) |
| Authorized Official Contact | 6122203441 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ametrine Mental Health Pllc 14802 1st Ave E Atwater MN 56209-9407 Ph: (612) 220-3441 | Ametrine Mental Health Pllc 194 Progress Way Spicer MN 56288-5000 Ph: (320) 640-2891 |
| NPI Number | 1902526437 |
|---|---|
| Provider Enumeration Date | 09/02/2022 |
| Last Update Date | 04/12/2023 |
| Certification Date | 04/12/2023 |
| Medicare PECOS PAC ID | 4385009943 |
|---|---|
| Medicare Enrollment ID | O20230503002903 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902526437 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Secondary |
| 363LP0808X | Nurse Practitioner - Psychiatric/mental Health | (* (Not Available)) | Primary |
| Provider Name | Stephanie J Olson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760810493 PECOS PAC ID: 6608003215 Enrollment ID: I20131205000715 |
| Provider Name | Katie M Nystrom |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1699355339 PECOS PAC ID: 8224438213 Enrollment ID: I20210614000519 |
| Provider Name | Janaya J Evenson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083371884 PECOS PAC ID: 4284029075 Enrollment ID: I20220314000950 |