Provider Demographics
NPI:1386130136
Name:ELLINGSTAD, JUSTIN J (PA-C)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:J
Last Name:ELLINGSTAD
Suffix:
Gender:
Credentials:PA-C
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Mailing Address - Street 1:719 W HAMILTON AVE
Mailing Address - Street 2:STE B
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-6970
Mailing Address - Country:US
Mailing Address - Phone:715-552-9784
Mailing Address - Fax:715-835-6370
Practice Address - Street 1:617 W CLAIREMONT AVE
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-6223
Practice Address - Country:US
Practice Address - Phone:715-834-2788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-05
Last Update Date:2025-04-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI4434363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant