Provider Demographics
NPI:1699663575
Name:ELLENBECKER, JORI ANNE
Entity type:Individual
Prefix:
First Name:JORI
Middle Name:ANNE
Last Name:ELLENBECKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4511 E 53RD ST UNIT A
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57110-5305
Mailing Address - Country:US
Mailing Address - Phone:605-370-4581
Mailing Address - Fax:
Practice Address - Street 1:910 E 20TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1012
Practice Address - Country:US
Practice Address - Phone:605-334-6730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-27
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR054035163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care