Individual
ELLEN FASTNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
11269 JEFFERSON HWY N, CHAMPLIN, MN 55316
(763) 236-0600
Mailing address
2925 CHICAGO AVE, MINNEAPOLIS, MN 55407-1321
(612) 262-5000
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
1284
MN
363LF0000X
Family Nurse Practitioner
Primary
R126105-5
MN
Other
Enumeration date
07/30/2014
Last updated
06/04/2018
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