Healthcare Provider Details

I. General information

NPI: 1235069923
Provider Name (Legal Business Name): ELLEN LUCILLE ECKERT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 N BROAD ST STE 200
MANKATO MN
56001-3569
US

IV. Provider business mailing address

201 N BROAD ST STE 200
MANKATO MN
56001-3569
US

V. Phone/Fax

Practice location:
  • Phone: 507-225-1500
  • Fax: 507-225-1501
Mailing address:
  • Phone: 507-225-1500
  • Fax: 507-225-1501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: