| Doctor Name: | JENNIFER SUSAN ELLIS |
| NPI Number: | 1013986611 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA-C |
| License Number: | 9602 |
| Business Practice Address: | 1185 Towne Centre Dr Ste 100 Eagan, MN - 551231188 |
| Business Phone Number: | 6517673030 |
| Business Fax Number: | 6517673031 |
| Mailing Address: | Po Box 86 Sds 12 2901, MINNEAPOLIS |
| State: | MN |
| Postal Code: | 554862901 |
| Phone Number: | 6519685050 |
| Fax Number: | 6519685900 |
| NPI Enumeration Date: | 03/16/2006 |
| NPI Last Update Date: | 10/26/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AS0400X |
| License Number: | 9602 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Surgical |
| Taxonomy Definition: | |