Individual
LORI ELLINGSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1240 25TH ST S, FARGO, ND 58103-2367
(701) 241-1360
(701) 241-8559
Mailing address
1240 25TH ST S, FARGO, ND 58103-2367
(701) 241-1360
(701) 241-8559
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R23711
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
167M7LA
BCBS
MN
01
—
19638
BCBS
ND
05
—
264304900
—
MN
Enumeration date
10/26/2006
Last updated
10/08/2015
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