DONNA ELLENSON (NPI# 1912200585) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1912200585 |
| Entity Type | Individual |
| Full Name | DONNA ELLENSON |
| Credential | PA |
| Practice Address |
737 Broadway N Fargo ND 58102-4421 |
| Mailing Address |
Po Box 2010 Fargo ND 58122-0001 |
| Practice Telephone | 7012342251 |
| Mailing Telephone | 7012342251 |
| Enumeration Date | 2010-12-21 |
| Last Update Date | 2010-12-21 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
PAC0198 | ND | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
737 BROADWAY N |
| City | FARGO |
| State | ND |
| Zip Code | 58102-4421 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023040219 | Jerome I Thompson | Surgery | 737 Broadway N, Fargo, ND 58122-0001 | 2006-07-07 |
| 1376160184 | Michael Andrew Kerr | Family Medicine | 737 Broadway N, Fargo, ND 58102-4421 | 2020-06-26 |
| 1124645064 | Shelby Rae Bucholz | Family Medicine | 737 Broadway N, Fargo, ND 58102-4421 | 2020-06-26 |
| 1700431756 | Joshua Jacob Fisher | Family Medicine | 737 Broadway N, Fargo, ND 58102-4421 | 2019-08-06 |
| 1689229122 | Michael Seaman | Family Medicine | 737 Broadway N, Fargo, ND 58102-4421 | 2019-08-01 |
| 1467004838 | Fiona Lillian Axelsson | Family Medicine | 737 Broadway N, Fargo, ND 58102-4421 | 2019-07-15 |
| 1477115145 | Anuj Mogla | Family Medicine | 737 Broadway N, Fargo, ND 58102-4421 | 2019-07-02 |
| 1376105304 | Erika Singh | Family Medicine | 737 Broadway N, Fargo, ND 58102-4421 | 2019-06-29 |
| 1467947564 | Katrina Lee Foster | Family Medicine | 737 Broadway N, Fargo, ND 58102-4421 | 2018-06-30 |
| 1629590104 | Evelyn Fuentes-dondoneau | Family Medicine | 737 Broadway N, Fargo, ND 58102-4421 | 2017-07-17 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780285924 | Shelley Dene Townsend-hansen | Dentist | 1017 Broadway N, Fargo, ND 58102 | 2020-11-04 |
| 1275190779 | Anthony Joseph Duncan | Student in an Organized Health Care Education/Training Program | 1919 Elm Streent North, Fargo, ND 58102 | 2019-05-21 |
| 1003472317 | Sadie Marie Nelson | Nurse Practitioner | Sanford Broadway Clinic, 801 North Broadway, Fargo, ND 58102 | 2019-05-13 |
| 1124523576 | Christopher Peroutka | Specialist/Technologist | 1300 17th Ave N, Fargo, ND 58102 | 2018-03-28 |
| 1205331873 | Nathan Koens | Specialist/Technologist | 1300 17th Avenue North, Fargo, ND 58102 | 2018-03-27 |
| 1376063370 | Abby Nicole Fredrickson | Student in an Organized Health Care Education/Training Program | 1919 Elm Street North, Fargo, ND 58102 | 2017-06-21 |
| 1780118331 | Stephanie Melquist | Internal Medicine | Internal Medicine Resident Clinic, 801 N Broadway, Fargo, ND 58102 | 2017-04-19 |
| 1104215623 | Justin Lervik | Social Worker | 211 Elm St. N, 122, Fargo, ND 58102 | 2015-01-21 |
| 1770919441 | Courtney Ann Simanski | Speech-Language Pathologist | 415 4th St. N., Fargo, ND 58102 | 2013-09-25 |
| 1821431206 | Lanell Staroba | Pharmacist | 706 D 38th St, Fargo, ND 58102 | 2013-04-16 |
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| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205015633 | Jamie M Brown | Physician Assistant | 1711 Gold Dr S, Suite 170, Fargo, ND 58103-6416 | 2007-11-02 |
| 1790703353 | Mary Jane Kadry | Physician Assistant | 1121 Westrac Dr S Ste 204, Fargo, ND 58103-2385 | 2006-07-18 |
| 1861419723 | Catherine M Garvey | Physician Assistant | 2801 University Dr S, Fargo, ND 58103-6029 | 2006-07-16 |
| 1881148005 | Kali Luecke | Physician Assistant | 301 Np Ave N, Fargo, ND 58102-4835 | 2016-08-04 |
| 1215480009 | Jason Byrne Smith | Physician Assistant | 801 Broadway N, Fargo, ND 58102-3641 | 2016-07-27 |
| 1659758381 | Sarah Winter | Physician Assistant | 1702 University Dr S, Fargo, ND 58103-4940 | 2015-05-01 |
| 1861801763 | Lisa Lynn Froemke | Physician Assistant | 3838 12th Ave N, Fargo, ND 58102-2931 | 2014-08-05 |
| 1033525365 | Kathryn Gray | Physician Assistant | 301 Np Ave N, Fargo, ND 58102-4835 | 2014-07-08 |
| 1326462490 | Shannon Lynn Gullingsrud | Physician Assistant | 3000 32nd Ave S, Fargo, ND 58103-6132 | 2014-02-10 |
| 1467722702 | Yan Tesch | Physician Assistant | 2400 32nd Ave S, Fargo, ND 58103-5800 | 2012-01-04 |
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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.