Individual
ELLISE CAROLINE BRAVEHEART
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, CNP, FNP-C
Contact information
Practice address
927 TRETTEL LN, CLOQUET, MN 55720-1345
(218) 879-1227
Mailing address
907 SLATE ST, CLOQUET, MN 55720-1252
(218) 269-4974
Taxonomy
Speciality
Code
Description
License number
State
163WM0705X
Medical-Surgical Registered Nurse
R221785-9
MN
363LF0000X
Family Nurse Practitioner
Primary
9590
MN
Other
Enumeration date
11/21/2014
Last updated
01/03/2023
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