1942642681 NPI number — JEAN VANEPS CNP

Table of content: JEAN VANEPS CNP (NPI 1942642681)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942642681 NPI number — JEAN VANEPS CNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VANEPS
Provider First Name:
JEAN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ANDERSON
Provider Other First Name:
JEAN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1942642681
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/11/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 680
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DEER RIVER
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56636-0680
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-624-6562
Provider Business Mailing Address Fax Number:
218-249-1534

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
708 DIVISION ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEER RIVER
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56636-8706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-246-6286
Provider Business Practice Location Address Fax Number:
182-492-1534
Provider Enumeration Date:
07/23/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 364S00000X , with the licence number:  R951803 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)