Individual
ELENA ROSE COWEN BANTLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
211 S BOUNDARY AVE, DULUTH, MN 55810-2306
(218) 576-0200
Mailing address
400 E 3RD ST, DULUTH, MN 55805-1951
(218) 786-8364
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
14385
MN
Other
Enumeration date
10/31/2021
Last updated
03/03/2023
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