Provider Demographics
NPI:1295061935
Name:ELSEN, DEBORAH LYNN (RN CDE)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:LYNN
Last Name:ELSEN
Suffix:
Gender:F
Credentials:RN CDE
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Other - First Name:
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Mailing Address - Street 1:6401 UNIVERSITY AVE NE
Mailing Address - Street 2:#200
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-4341
Mailing Address - Country:US
Mailing Address - Phone:763-586-5883
Mailing Address - Fax:763-571-3088
Practice Address - Street 1:6401 UNIVERSITY AVE NE
Practice Address - Street 2:#200
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-4341
Practice Address - Country:US
Practice Address - Phone:763-586-5883
Practice Address - Fax:763-571-3088
Is Sole Proprietor?:No
Enumeration Date:2009-10-31
Last Update Date:2009-10-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MNR 078463-0163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator