Individual
NOELLE ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
13980 NORTHDALE BLVD, ROGERS, MN 55374-2147
(763) 428-1920
Mailing address
13980 NORTHDALE BLVD, ROGERS, MN 55374-2147
(763) 428-1920
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
113046
MN
390200000X
Student in an Organized Health Care Education/Training Program
—
MN
Other
Enumeration date
06/12/2012
Last updated
07/21/2022
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