NOELLE ELLIS (NPI# 1376805770) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1376805770 |
| Entity Type | Individual |
| Full Name | NOELLE ELLIS |
| Credential | MD |
| Practice Address |
13980 Northdale Blvd Rogers MN 55374-2147 |
| Practice Telephone | 7634281920 |
| Mailing Telephone | (763) 428-1920 |
| Enumeration Date | 2012-06-12 |
| Last Update Date | 2018-03-17 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208000000X | Pediatrics | 113046 | MN | Allopathic & Osteopathic Physicians |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | MN | Student, Health Care |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 2450 Riverside Ave, Minneapolis, MN 554541450 | 7634394943 |
| Street Address |
13980 NORTHDALE BLVD |
| City | ROGERS |
| State | MN |
| Zip Code | 55374-2147 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760459259 | Mary E. Mahony | Pediatrics | 13980 Northdale Blvd, Rogers, MN 55374-2147 | 2006-03-02 |
| 1609384973 | Katherine Wahl | Registered Nurse | 13980 Northdale Blvd, Rogers, MN 55374 | 2018-01-19 |
| 1063481513 | William N. Kunau | Nurse Practitioner | 13980 Northdale Blvd, Rogers, MN 55374-2147 | 2006-03-16 |
| 1629046412 | Naomi C. Palmer | Pediatrics | 13980 Northdale Blvd, Rogers, MN 55374-2147 | 2006-03-09 |
| 1649247859 | Wade M. Larson | Pediatrics | 13980 Northdale Blvd, Rogers, MN 55374-2147 | 2006-03-07 |
| 1700853397 | Andrew W. Larson | Pediatrics | 13980 Northdale Blvd, Rogers, MN 55374-2147 | 2006-03-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609335835 | Rebecca Loehrer | Nurse Practitioner | 21370 Ste 210 John Milless Dr., Rogers, MN 55374 | 2019-03-18 |
| 1255722328 | Samantha Colai | Marriage & Family Therapist | 21307 John Milless Drive, Suite 106, Rogers, MN 55374 | 2015-02-11 |
| 1437559648 | Jamie Mosley | Counselor | 2100 Rogers Drive, Suite 200, Rogers, MN 55374 | 2014-08-26 |
| 1295145886 | Marisa Kolasa | Massage Therapist | 22290 Oakdale Drive, Rogers, MN 55374 | 2014-05-05 |
| 1871878165 | Derek P Doty Dc Inc | Chiropractor | 21410 136th Ave N, Suite 105a, Rogers, MN 55374 | 2011-10-18 |
| 1912205865 | Michelle Cheryl Finnegan-larson | Registered Nurse | 21308 John Milless Drive, Rogers, MN 55374 | 2011-03-02 |
| 1639402571 | Ascend Family Institute | Community/Behavioral Health | 20980 Rogers Drive, #400, Rogers, MN 55374 | 2009-09-10 |
| 1275738403 | Nicole M Clements | Physician Assistant | 1355 Rogers Drive, Rogers, MN 55374 | 2007-06-18 |
| 1558566166 | Grand St Paul Cvs LLC | Durable Medical Equipment & Medical Supplies | 21455 John Milless Drive, Rogers, MN 55374 | 2007-06-15 |
| 1811062854 | Randall Alvin Hohbein | Pharmacist | 21351 John Milless Drive, Rogers Drug, Rogers, MN 55374 | 2006-11-22 |
| Find all providers in zip 55374 | ||||
| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497190797 | Medical Associates of Northwest Arkansas Pa | Pediatrics | 3730 S Pinnacle Hills Pkwy Ste 3, Rogers, AR 72758 | 2013-05-01 |
| 1215132253 | Rainbow Pediatric Clinic | Pediatrics | 5507 Walsh Ln Ste 101, Rogers, AR 72758-9007 | 2007-06-19 |
| 1184825408 | Apn Rainbow Pediatric Services, Pllc | Pediatrics | 5507 Walsh Lane, Ste 101, Rogers, AR 72758-8941 | 2007-05-31 |
| 1730122102 | Craig Keever | Pediatrics | 5507 W Walsh Ln Ste 101, Rogers, AR 72758-9007 | 2006-06-14 |
| 1306808829 | Luis M Carrasco | Pediatrics | 1233 West Poplar, Rogers, AR 72756-4249 | 2006-04-03 |
| 1760459259 | Mary E. Mahony | Pediatrics | 13980 Northdale Blvd, Rogers, MN 55374-2147 | 2006-03-02 |
| 1104810126 | Martha Ann B Sharkey | Pediatrics | 5507 Walsh Ln, Suite 101, Rogers, AR 72758-8941 | 2005-09-06 |
| 1417301417 | Shaun Daniel Adams | Pediatrics | 2710 S Rife Medical Ln, Rogers, AR 72758-1452 | 2016-04-16 |
| 1568825438 | Amy Randall | Pediatrics | 1233 W Poplar St, Rogers, AR 72756-4245 | 2016-03-30 |
| 1912392176 | Integritas LLC | Pediatrics | 2103 S 54th St, Suite 1, Rogers, AR 72758-8169 | 2015-04-03 |
| Find all providers in ROGERS | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.