Healthcare Provider Details

I. General information

NPI: 1952082737
Provider Name (Legal Business Name): ELLA ROSE MOTZKO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2023
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8301 GOLDEN VALLEY RD STE 100
GOLDEN VALLEY MN
55427-4469
US

IV. Provider business mailing address

8301 GOLDEN VALLEY RD STE 100
GOLDEN VALLEY MN
55427-4469
US

V. Phone/Fax

Practice location:
  • Phone: 763-581-5150
  • Fax: 763-581-5151
Mailing address:
  • Phone: 763-581-5150
  • Fax: 763-581-5151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number15524
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: