Individual
MS. ELLYN MARIE PHEARMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
251 COUNTY ROAD 120, SAINT CLOUD, MN 56303-4872
(320) 202-8949
(320) 257-1733
Mailing address
85 S UNION BLVD APT 514, DENVER, CO 80228-2289
(206) 551-7626
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
12813
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12813
MINNESOTA PHYSICIAN ASSISTANT LICENSE
MN
01
—
PA.0005431
COLORADO DEPARTMENT OF REGULATORY AGENCIES
CO
Enumeration date
11/15/2018
Last updated
11/15/2018
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