Individual
MS. ELLEN B ELLICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
1245 15TH ST N, SAINT CLOUD, MN 56303-1802
(320) 203-2087
Mailing address
1245 15TH ST N, SAINT CLOUD, MN 56303-1802
(320) 203-2087
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
R 059057-8
MN
Other
Enumeration date
12/19/2007
Last updated
12/19/2007
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