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Individual

ELLESE MARIE FORD

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
6000 BASS LAKE RD, SUITE 105, CRYSTAL, MN 55429-2700
(612) 998-9838
(763) 432-3919
Mailing address
6000 BASS LAKE RD, SUITE 105, CRYSTAL, MN 55429-2700
(612) 998-9838
(763) 432-3919

Taxonomy

Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary
MN

Other

Enumeration date
03/11/2014
Last updated
03/11/2014
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