Healthcare Provider Details

I. General information

NPI: 1053082446
Provider Name (Legal Business Name): RIVER CITY PSYCHIATRIC SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2021
Last Update Date: 01/18/2025
Certification Date: 01/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 E 2ND ST STE 113
WINONA MN
55987-6355
US

IV. Provider business mailing address

902 E 2ND ST STE 113
WINONA MN
55987-6355
US

V. Phone/Fax

Practice location:
  • Phone: 507-208-7629
  • Fax: 507-607-8671
Mailing address:
  • Phone: 507-208-7629
  • Fax: 507-607-8671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SHEILA M DUNN
Title or Position: OWNER
Credential: CNP, PMHNP-BC
Phone: 507-208-7629