DataLabs
datalabs.health made in the usa
DataLabs Facebook Wall   Like   Follow DataLabs on Twitter   Tweet  
Contact us Sign in |  Documentation | 
NPI Code Detail

MEDICARE: JENNIFER SUSAN ELLIS PA-C

MEDICARE: JENNIFER SUSAN ELLIS PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AS0400XSurgical Physician Assistant9602MN
2363A00000XPhysician Assistant9602MN

General Provider Information

NPI Number : 1013986611
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER SUSAN ELLIS PA-C
Provider Business Mailing Address
First Line : 4200 DAHLBERG DR STE 300
Second Line :
City : GOLDEN VALLEY
State : MN
Zip : 55422-4841
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4040 RADIO DR
Second Line :
City : WOODBURY
State : MN
Zip : 55129-3237
Country : US
Telephone Number : 651-439-8807
Fax Number : 651-439-0232
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/16/2006
Last Update Date : 09/25/2020

Similar Medicare Providers

1063413250 — MR. DANIEL PAUL SPIELMAN APRN, CNP
Practice Location Address:
4040 RADIO DR
WOODBURY, MN
55129-3237
Practice Phone: 651-439-8807
Practice Fax: 651-439-0232
1760455208 — ELLEN R SHAMMASH MD
Practice Location Address:
4040 RADIO DR
WOODBURY, MN
55129-3237
Practice Phone: 651-439-8807
Practice Fax: 651-439-0232
1114993961 — SOU-PAN WU MD
Practice Location Address:
4040 RADIO DR
WOODBURY, MN
55129-3237
Practice Phone: 651-439-8807
Practice Fax: 651-439-0232
1659387637 — DANA LYNN KAUFMAN PAC
Practice Location Address:
4040 RADIO DR
WOODBURY, MN
55129-3237
Practice Phone: 651-439-8807
Practice Fax: 651-439-0232
1114015997 — MARYANN S JOHNSON PT
Practice Location Address:
4040 RADIO DR
WOODBURY, MN
55129-3237
Practice Phone: 651-439-8807
Practice Fax:
1891994067 — DR. SHARON LYNN FRATTALONE D.O.
Practice Location Address:
4040 RADIO DR
WOODBURY, MN
55129-3237
Practice Phone: 651-439-8807
Practice Fax: 651-439-0232

Directions to “ JENNIFER SUSAN ELLIS PA-C” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.