Ellis, Jennifer Susan

Ellis, Jennifer Susan is an individual health care provider with primary practice located at 4040 Radio Dr , Woodbury MN 55129-3237. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Surgical, Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant. Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant is her primary health care specialty. Ellis, Jennifer Susan can be contacted via phone (651) 439-8807.

Contact Information

Primary practice address
4040 Radio Dr Woodbury MN 55129-3237
Phone: (651) 439-8807
Fax: (651) 439-0232
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Surgical 363AS0400X 9602 Minnesota
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 9602 Minnesota

Profile Details

NPI number 1013986611
LBN Legal business name Ellis, Jennifer Susan
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 16th, 2006
Last updated Sep 25th, 2020 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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