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General NPI Number Information
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NPI Number | 1962473710
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Entity Type | Organization
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Legal Business Name | STEVENS TRAVERSE GRANT PUBLIC HEALTH
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Dates
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Enumeration Date | 01/30/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 621 PACIFIC AVENUE
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City | MORRIS
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State | MN
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Zip | 56267
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Country | US
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Telephone | 320-589-7425
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Fax | 320-589-7433
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Provider Business Mailing Address
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Address Line | 621 PACIFIC AVENUE
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City | MORRIS
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State | MN
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Zip | 56267
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Country | US
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Telephone | 320-589-7425
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Fax | 320-589-7433
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. BETTY WINDOM-KIRSCH
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Credential | RN PHN DIRECTOR
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Telephone | 320-589-7425
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number | 328493
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License Number State | MN
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