Provider Demographics
NPI:1831763580
Name:ELLEFSON, ASHLEY AMBER (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:AMBER
Last Name:ELLEFSON
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24930 CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55024-8014
Mailing Address - Country:US
Mailing Address - Phone:651-468-1432
Mailing Address - Fax:
Practice Address - Street 1:24930 CEDAR AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55024-8014
Practice Address - Country:US
Practice Address - Phone:651-468-1432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2478232163W00000X
MN939091146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic