Individual
DR. NICHOLAS C. ELLEFSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
3500 TOWER AVE, SUPERIOR, WI 54880-4491
(715) 817-7100
(715) 817-7039
Mailing address
1702 UNIVERSITY DR S, FARGO, ND 58103-4940
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
3356
WV
207Q00000X
Family Medicine Physician
66646
MN
207Q00000X
Family Medicine Physician
Primary
71579-21
WI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/23/2017
Last updated
06/19/2020
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