Individual
JUDITH MARIE ELLERBUSCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2277 HIGHWAY 36 W, ROSEVILLE, MN 55113-3804
(651) 631-0065
Mailing address
290 CEDAR COVE LN, OWATONNA, MN 55060-4200
(507) 446-8055
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
R846552
MN
Other
Enumeration date
11/17/2011
Last updated
11/17/2011
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