MEDICARE: ELISSA GEMPHEL APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	13282	MN

General Provider Information

NPI Number	:	1487534160
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELISSA GEMPHEL APRN

Provider Business Mailing Address
First Line	:	10920 RIVER PINES DR N
Second Line	:
City	:	CHAMPLIN
State	:	MN
Zip	:	55316-4503
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	150 3RD AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55401-2557
Country	:	US
Telephone Number	:	612-472-5915
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/04/2025
Last Update Date	:	01/23/2026

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