Provider Demographics
NPI:1437721446
Name:ELLENSOHN, JESSICA LOUISE (ARNP)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:LOUISE
Last Name:ELLENSOHN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 LAUREL ST STE A300
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50314-3030
Mailing Address - Country:US
Mailing Address - Phone:515-282-2921
Mailing Address - Fax:
Practice Address - Street 1:411 LAUREL ST STE A300
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-3030
Practice Address - Country:US
Practice Address - Phone:515-282-2921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-11
Last Update Date:2022-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAH164472363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner