Provider Demographics
NPI:1255092417
Name:VARNEY, ELICE LEANNE
Entity type:Individual
Prefix:
First Name:ELICE
Middle Name:LEANNE
Last Name:VARNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5653 ALPS CT NW TRLR 55
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-9091
Mailing Address - Country:US
Mailing Address - Phone:701-261-9560
Mailing Address - Fax:
Practice Address - Street 1:5653 ALPS CT NW TRLR 55
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-9091
Practice Address - Country:US
Practice Address - Phone:701-261-9560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-10
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171W00000XOther Service ProvidersContractor
No172A00000XOther Service ProvidersDriver
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle
No376J00000XNursing Service Related ProvidersHomemaker