Healthcare Provider Details

I. General information

NPI: 1780511659
Provider Name (Legal Business Name): ELLENA WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 SE MAIN ST STE 235
MINNEAPOLIS MN
55414-2143
US

IV. Provider business mailing address

125 SE MAIN ST STE 235
MINNEAPOLIS MN
55414-2143
US

V. Phone/Fax

Practice location:
  • Phone: 262-719-6184
  • Fax:
Mailing address:
  • Phone: 262-719-6184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DEVON ELLENA
Title or Position: OWNER
Credential:
Phone: 262-719-6184