Provider Demographics
NPI:1912383258
Name:ROSSER, ELLEN (AGNP)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:ROSSER
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 FEDERAL DR STE 1950
Mailing Address - Street 2:
Mailing Address - City:FORT SNELLING
Mailing Address - State:MN
Mailing Address - Zip Code:55111-4080
Mailing Address - Country:US
Mailing Address - Phone:612-505-6369
Mailing Address - Fax:
Practice Address - Street 1:1 FEDERAL DR STE 1950
Practice Address - Street 2:
Practice Address - City:FORT SNELLING
Practice Address - State:MN
Practice Address - Zip Code:55111-4080
Practice Address - Country:US
Practice Address - Phone:612-505-6369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-10
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAH136051363LA2200X
NE111880364SG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No364SG0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontology