Provider Demographics
NPI:1194614529
Name:KITTELSON, ELLA JO
Entity type:Individual
Prefix:
First Name:ELLA
Middle Name:JO
Last Name:KITTELSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 17
Mailing Address - Street 2:
Mailing Address - City:HOOPLE
Mailing Address - State:ND
Mailing Address - Zip Code:58243-0017
Mailing Address - Country:US
Mailing Address - Phone:701-331-0694
Mailing Address - Fax:
Practice Address - Street 1:8459 HWY 32
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:ND
Practice Address - Zip Code:58227
Practice Address - Country:US
Practice Address - Phone:701-331-9425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-01
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant