Evygabs Healthcare Systems LLC.

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

R-161456-3 Issued in MN

Legal business name

EVYGABS HEALTHCARE SYSTEMS LLC.

Practice address

20604 Enfield Ave N
Forest Lake, MN 55025-8137

Phone

(651) 492-8643

NPI assigned

Jul 1, 2017

Last updated

Jul 21, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Gabriel Mba

Title

Co-Founder

Phone

(651) 492-8643

Specialties & licenses 2

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1498867200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1396266128",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20604 ENFIELD AVE N",
            "city": "FOREST LAKE",
            "state": "MN",
            "postal_code": "550258137",
            "telephone_number": "651-492-8643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20604 ENFIELD AVE N",
            "city": "FOREST LAKE",
            "state": "MN",
            "postal_code": "550258137",
            "telephone_number": "651-492-8643"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVYGABS HEALTHCARE SYSTEMS LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-01",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "MBA",
        "authorized_official_first_name": "GABRIEL",
        "authorized_official_title_or_position": "CO-FOUNDER",
        "authorized_official_telephone_number": "651-492-8643"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NU",
            "license": "R-161456-3",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MN",
            "license": "R-161456-3",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Diane Lynn Eide, R.N
• Serene Eidem
• Kari Lynn Eliason, O.D.
• Eric M Knaff P.a.
• Julie Eschenlauer, PSY.D.
• Fairview Express Care (M Health Fairview Counseling Forest Lake)
• Fairview Health Services (Fairview Recovery Services)
• Brenda Lee Fandel, D.C.
• Colleen Michelle Flaten
• Neh Buma Foncham, PSYCHIATRIC NP

• Registered Nurse in Forest Lake, MN
• Providers in Forest Lake, MN by specialty
• Registered Nurse in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.