Provider Demographics
NPI:1669401345
Name:TEIGLAND, ELLEN S (MS, APRN, BC, LP)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:S
Last Name:TEIGLAND
Suffix:
Gender:F
Credentials:MS, APRN, BC, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 NE 3RD ST
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55744-2742
Mailing Address - Country:US
Mailing Address - Phone:218-326-7089
Mailing Address - Fax:218-327-3173
Practice Address - Street 1:25 NE 3RD ST
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55744-2742
Practice Address - Country:US
Practice Address - Phone:218-326-7089
Practice Address - Fax:218-327-3173
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP2283103T00000X
MN364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNR05184Medicare UPIN