Healthcare Provider Details

I. General information

NPI: 1104445881
Provider Name (Legal Business Name): ELLA TREPASHKO HARPOLE PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2020
Last Update Date: 10/25/2022
Certification Date: 10/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1997 SLOAN PL STE 17
MAPLEWOOD MN
55117-2051
US

IV. Provider business mailing address

2854 HIGHWAY 55 STE 130
EAGAN MN
55121-1447
US

V. Phone/Fax

Practice location:
  • Phone: 651-772-6251
  • Fax: 651-294-9661
Mailing address:
  • Phone: 651-842-3329
  • Fax: 651-842-3391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number4371
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number13298
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: