Provider Demographics
NPI:1013015841
Name:ELLLINGSON, LINDA H (PA-C)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:H
Last Name:ELLLINGSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 3RD AVE SW
Mailing Address - Street 2:
Mailing Address - City:RUGBY
Mailing Address - State:ND
Mailing Address - Zip Code:58368-1645
Mailing Address - Country:US
Mailing Address - Phone:701-776-5235
Mailing Address - Fax:701-776-5297
Practice Address - Street 1:301 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:MADDOCK
Practice Address - State:ND
Practice Address - Zip Code:58348-7138
Practice Address - Country:US
Practice Address - Phone:701-438-2555
Practice Address - Fax:701-438-2551
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDPAC0023363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDN18165OtherBLUE SHIELD
NDN18165OtherBLUE SHIELD