Individual
WALTER NICHOLAS ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
106 DOCTORS PARK, ST CLOUD, MN 56303-1207
(320) 251-5444
(320) 656-9590
Mailing address
106 DOCTORS PARK, ST CLOUD, MN 56303-1207
(320) 251-5444
(320) 656-9590
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
451
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
684025600
—
MN
Enumeration date
03/28/2006
Last updated
01/08/2015
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