Healthcare Provider Details

I. General information

NPI: 1104902808
Provider Name (Legal Business Name): MICHELLE A GEROW-ELLIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 01/24/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 WILLMAR AVE SW
WILLMAR MN
56201-3556
US

IV. Provider business mailing address

101 WILLMAR AVE SW
WILLMAR MN
56201-3556
US

V. Phone/Fax

Practice location:
  • Phone: 320-231-5000
  • Fax: 320-231-6323
Mailing address:
  • Phone: 320-231-5000
  • Fax: 320-231-6323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCNP1124
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberCNP1124
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: