Provider Demographics
NPI:1790399772
Name:SSENTONGO, EVA (DNP, FNP-BC)
Entity Type:Individual
Prefix:DR
First Name:EVA
Middle Name:
Last Name:SSENTONGO
Suffix:
Gender:F
Credentials:DNP, FNP-BC
Other - Prefix:
Other - First Name:EVA
Other - Middle Name:JOY
Other - Last Name:BRANDES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1184 ORANGE AVE E
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55106-2075
Mailing Address - Country:US
Mailing Address - Phone:507-398-2424
Mailing Address - Fax:
Practice Address - Street 1:7421 UNIVERSITY AVE NE
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-3118
Practice Address - Country:US
Practice Address - Phone:507-398-2424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-07
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1741973163W00000X
MN8320363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse