Individual
DIVINIA DEWAYNIA ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2365 MCKNIGHT RD N, NORTH ST PAUL, MN 55109-2238
(651) 370-2373
(651) 370-2373
Mailing address
8430 YUCCA LN N, MAPLE GROVE, MN 55369-4671
(651) 370-2373
(651) 760-3236
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
MN
Other
Enumeration date
02/06/2026
Last updated
02/06/2026
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