Provider Demographics
NPI:1851371462
Name:GIERE, ELLEN (CFNP)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:
Last Name:GIERE
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12678 DOVER DR
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-8668
Mailing Address - Country:US
Mailing Address - Phone:952-388-1053
Mailing Address - Fax:
Practice Address - Street 1:8645 EAGLE POINT BLVD
Practice Address - Street 2:
Practice Address - City:LAKE ELMO
Practice Address - State:MN
Practice Address - Zip Code:55042-8628
Practice Address - Country:US
Practice Address - Phone:651-493-2890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA190617363LA2200X
MNR 187349-8363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA190617OtherLICENSE
MAS88946Medicare UPIN
MAGINP1995Medicare ID - Type Unspecified