Provider Demographics
NPI:1457731127
Name:ELLISON, AMY M (CNP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:M
Last Name:ELLISON
Suffix:
Gender:
Credentials:CNP
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 211699
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55121-3699
Mailing Address - Country:US
Mailing Address - Phone:866-849-0692
Mailing Address - Fax:
Practice Address - Street 1:200 S WACKER DR
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60606-5829
Practice Address - Country:US
Practice Address - Phone:866-849-0692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-08
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ315543363L00000X
NC5021341363LF0000X
IL209012868363LF0000X, 363L00000X
HIAPRN-4938363LF0000X
MO2025003230363LF0000X
FL11035916363LF0000X
OH0037682363L00000X
IN71006091A363L00000X, 363LF0000X
PASP032117363L00000X
TN38142363LF0000X
TX1176681363LF0000X
AR231018363LF0000X
MS907204363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily