Healthcare Provider Details

I. General information

NPI: 1972807048
Provider Name (Legal Business Name): KANABEC COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2011
Last Update Date: 01/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 FOREST AVE E STE 127
MORA MN
55051-1632
US

IV. Provider business mailing address

905 FOREST AVE E STE 127
MORA MN
55051-1632
US

V. Phone/Fax

Practice location:
  • Phone: 320-679-6462
  • Fax: 320-679-6333
Mailing address:
  • Phone: 320-679-6462
  • Fax: 320-679-6333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347B00000X
TaxonomyBus
License Number374228
License Number StateMN

VIII. Authorized Official

Name: MS. HELEN M PIEPER
Title or Position: TRANSIT DIRECTOR
Credential:
Phone: 320-679-6462