Individual
HARLEY LYELL ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN, CNP
Contact information
Practice address
11855 STATE AVE, C.O.R.E. BRAINERD, BRAINERD, MN 56401-4127
(218) 828-2389
(218) 828-6165
Mailing address
1121 8TH ST S, BRAINERD, MN 56401-4127
(218) 829-0895
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R 092367-9
MN
Other
Enumeration date
11/17/2006
Last updated
07/08/2007
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