| Providence Psychiatry Services, Ltd. | |
|
502 Se 10th St Grand Rapids MN 55744-3921 | |
| (218) 246-6286 | |
| Not Available |
| Full Name | Providence Psychiatry Services, Ltd. |
|---|---|
| Speciality | Clinic/Center |
| Location | 502 Se 10th St, Grand Rapids, Minnesota |
| Authorized Official Name and Position | Jean M Vaneps (PSYCHIATRIC NURSE PRACTITIONER) |
| Authorized Official Contact | 2183981998 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Psychiatry Services, Ltd. 12860 Mud Lake Rd Ne Box 631 Deer River MN 56636-2174 Ph: (218) 398-1998 | Providence Psychiatry Services, Ltd. 502 Se 10th St Grand Rapids MN 55744-3921 Ph: (218) 246-6286 |
| NPI Number | 1871942953 |
|---|---|
| Provider Enumeration Date | 06/08/2016 |
| Last Update Date | 12/10/2025 |
| Certification Date | 12/10/2025 |
| Medicare PECOS PAC ID | 4284919200 |
|---|---|
| Medicare Enrollment ID | O20170314000348 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871942953 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | CNP2221 (Minnesota) | Primary |
| Provider Name | Jean M Vaneps |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942642681 PECOS PAC ID: 4587806013 Enrollment ID: I20170417000239 |
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