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General NPI Number Information
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NPI Number | 1871942953
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Entity Type | Organization
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Legal Business Name | PROVIDENCE PSYCHIATRY SERVICES, LTD.
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Dates
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Enumeration Date | 06/08/2016
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Last Update Date | 12/10/2025
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Provider Practice Location Address
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Address Line | 502 SE 10TH ST
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City | GRAND RAPIDS
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State | MN
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Zip | 55744-3921
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Country | US
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Telephone | 218-246-6286
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Fax |
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Provider Business Mailing Address
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Address Line | 12860 MUD LAKE RD NE BOX 631
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City | DEER RIVER
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State | MN
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Zip | 56636-2174
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Country | US
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Telephone | 218-398-1998
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Fax |
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Authorized Official
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Title or Position | PSYCHIATRIC NURSE PRACTITIONER
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Name | MS. JEAN M VANEPS
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Credential | APRN
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Telephone | 218-398-1998
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | CNP2221
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License Number State | MN
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