Provider Demographics
NPI:1962800169
Name:EVELYN NERENBERG
Entity type:Organization
Organization Name:EVELYN NERENBERG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:M
Authorized Official - Last Name:SCHULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-224-1905
Mailing Address - Street 1:5780 LINCOLN DR
Mailing Address - Street 2:SUITE 124
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55436-1640
Mailing Address - Country:US
Mailing Address - Phone:952-935-3472
Mailing Address - Fax:
Practice Address - Street 1:5780 LINCOLN DR
Practice Address - Street 2:SUITE 124
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55436-1640
Practice Address - Country:US
Practice Address - Phone:952-935-3472
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-21
Last Update Date:2014-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNH014710500900011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN800001869Medicare PIN