JACKLYN MAE ELLICKSON (NPI# 1538395496) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1538395496 |
| Entity Type | Individual |
| Full Name | JACKLYN MAE ELLICKSON |
| Credential | MD |
| Practice Address |
401 Phalen Bl Vd Ms 41103d St Paul MN 55130-5302 |
| Mailing Address |
Po Box 1309 Mail Stop 21110q Minneapolis MN 55440-1309 |
| Practice Telephone | 6512547870 |
| Practice Fax Number | 6512547876 |
| Mailing Telephone | 6512547870 |
| Mailing Fax Number | 9528538727 |
| Enumeration Date | 2009-06-05 |
| Last Update Date | 2018-04-18 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207RE0101X |
Internal Medicine Specialization: Endocrinology, Diabetes & Metabolism |
62721-20 | WI | Allopathic & Osteopathic Physicians |
| Y | 207RE0101X |
Internal Medicine Specialization: Endocrinology, Diabetes & Metabolism |
53921 | MN | Allopathic & Osteopathic Physicians |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 401 Phalen Blvd, Saint Paul, MN 551305302 | 6512547870 | 6512547876 |
| Street Address |
401 PHALEN BL VD MS 41103D |
| City | ST PAUL |
| State | MN |
| Zip Code | 55130-5302 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164904587 | Confident Care LLC | In Home Supportive Care | 1040 Arkwright Street, Saint Paul, MN 55130 | 2018-09-01 |
| 1881015253 | Lucas Bosco Wanga | Psychologist | 715 Edgerton Street, Merrick Community Services, St. Paul, MN 55130 | 2014-01-02 |
| 1174865570 | Sarang Patel | Internal Medicine | 401 Phalen Blvd # 41103d, Saint Paul, MN 55130 | 2013-03-23 |
| 1427394501 | Zongxee Lee | Registered Nurse | 1072 Payne Ave, St. Paul, MN 55130 | 2012-12-18 |
| 1740532753 | One Stop Medical Supply Inc | Durable Medical Equipment & Medical Supplies | 1049 Payne Ave Suite C, St Paul, MN 55130 | 2012-10-15 |
| 1689923997 | Alexis Simmons | Counselor | 402 University Ave East, Suite A-127, Saint Paul, MN 55130 | 2012-08-31 |
| 1689804064 | Group Health Plan, Inc. | Durable Medical Equipment & Medical Supplies | 537 Phalen Blvd, Saint Paul, MN 55130 | 2009-07-21 |
| 1477756534 | Chad Everett Christensen | Chiropractor | 1073 Payne Ave, Saint Paul, MN 55130 | 2007-06-07 |
| 1922219021 | Qwik Urgent Care Clinic | Family Medicine | 1239 Payne Avenue, Saint Paul, MN 55130 | 2007-05-24 |
| 1275743981 | Yia Vang | Technician | 1100 Arkwright St., St. Paul, MN 55130 | 2007-05-23 |
| Find all providers in zip 55130 | ||||
| Taxonomy Code | 207RE0101X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Endocrinology, Diabetes & Metabolism |
| An internist who concentrates on disorders of the internal (endocrine) glands such as the thyroid and adrenal glands. This specialist also deals with disorders such as diabetes, metabolic and nutritional disorders, obesity, pituitary diseases and menstrual and sexual problems. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164484960 | Puneet S Arora | Internal Medicine | 401 Phalen Blvd, Mail Stop 41103d, St Paul, MN 55101-5302 | 2006-04-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538697818 | Mohammed Nmn Ahmed | Internal Medicine | 9055 Spring Brook Drive, Allina Coon Rapids Clinic 9055, Coon Rapids, MN 55433 | 2017-05-31 |
| 1174865570 | Sarang Patel | Internal Medicine | 401 Phalen Blvd # 41103d, Saint Paul, MN 55130 | 2013-03-23 |
| 1821245960 | Columba Alphonsus Gorman | Internal Medicine | 2607 Merrihills Dr Sw, Rochester, MN 55902-1168 | 2008-08-20 |
| 1861547382 | Lawrence D Schuster | Internal Medicine | 4999 France Ave S Ste 255, Minneapolis, MN 55410-1734 | 2007-01-24 |
| 1497804496 | Christopher Mark Schoonover | Internal Medicine | 255 Smith Avenue No #100, United Medical Specialties, St. Paul, MN 55102 | 2007-01-09 |
| 1235225160 | Charles John Billington | Internal Medicine | Minneapolis Vamc, Metabolic Section (111g), One Veterans Drive, Minneapolis, MN 55417 | 2006-10-05 |
| 1376651786 | Nacide Ercan-fang | Internal Medicine | Mpls Va Medical Center One Veterans Drive, 111g Endocrine/metabolic, Minneapolis, MN 55417 | 2006-08-26 |
| 1891703005 | Sindhu M. Devani | Internal Medicine | 1900 Centracare Dr #2500, Centracare Clinic- Health Plaza Specialties/endocrinolo, St Cloud, MN 56303 | 2006-08-03 |
| 1508806811 | Sidney Amos Jones | Internal Medicine | 111 Hundertmark Rd Ste 115n, Chaska, MN 55318-1584 | 2006-06-07 |
| 1679532022 | Thomas William Laedtke | Internal Medicine | 7701 York Ave S, Suite 180, Edina, MN 55435 | 2006-03-22 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.