Healthcare Provider Details

I. General information

NPI: 1679326862
Provider Name (Legal Business Name): MEDCANVAS PSYCHIATRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2024
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 10TH AVE SE
MINOT ND
58701-4810
US

IV. Provider business mailing address

1940 S BROADWAY # 420
MINOT ND
58701-6508
US

V. Phone/Fax

Practice location:
  • Phone: 307-448-0376
  • Fax:
Mailing address:
  • Phone: 701-581-5395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
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

VIII. Authorized Official

Name: DIANA NTOE ARRAH
Title or Position: FOUNDER
Credential:
Phone: 307-448-0376