Provider Demographics
NPI:1033484647
Name:FLANNERY, ELLIE (RN, CPNP)
Entity Type:Individual
Prefix:MRS
First Name:ELLIE
Middle Name:
Last Name:FLANNERY
Suffix:
Gender:F
Credentials:RN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5046 EVEREST LN N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55446-4520
Mailing Address - Country:US
Mailing Address - Phone:612-669-8725
Mailing Address - Fax:
Practice Address - Street 1:5046 EVEREST LN N
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55446-4520
Practice Address - Country:US
Practice Address - Phone:612-669-8725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-14
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN20091436363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics