Individual
LARRY VERNON ELJ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
516 SOUTH POKEGAMA AVE, GRAND RAPIDS, MN 55744-3800
(218) 327-2001
(218) 327-0456
Mailing address
308 1ST ST NW, CHISHOLM, MN 55719-1704
(218) 969-9968
Taxonomy
Speciality
Code
Description
License number
State
273R00000X
Psychiatric Hospital Unit
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
7856
MN
Other
Enumeration date
09/25/2020
Last updated
11/23/2020
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