Individual
AMANDA ELLINGSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
2701 12TH AVE S, FARGO, ND 58103-8753
(701) 451-4900
Mailing address
2701 12TH AVE S, FARGO, ND 58103-8753
(701) 451-4900
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
R34720
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R34720
ND REGISTERED NURSE LICENSE
ND
Enumeration date
10/03/2019
Last updated
10/03/2019
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