Mattie Rose Ellenson, APRN, CNP
Individual provider Active NPI Women's Health Nurse Practitioner · Staples, MN
NPI 1316579337 · NPPES record last updated Sep 23, 2025
Key facts
- NPI
- 1316579337
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Women's Health Nurse Practitioner 363LW0102X
- License
- 12090 (MN)
- Practice address
- 49725 County 83
Staples, MN 56479-5280 - Phone
- (218) 894-1515
- Fax
- (218) 898-7518
- NPI assigned
- Feb 7, 2020
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 16
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- University of Minnesota Medical School, 2024
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Lakewood Health System
Practice addresses (Care Compare)
49725 County
Suite 83
Staples, MN 56479-5280
Phone (218) 894-1515
Hospital & facility affiliations
- Lakewood Health System
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250417000634 | MN | Practitioner - Nurse Practitioner | 9830614353 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Certified Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lakewood Health System | Current |
Accepting new patients | |
| Lakewood Health System | Current |
Accepting new patients | |
| Lakewood Health System | Current |
Accepting new patients | |
| Otter Tail County Auditor | Public Health Or Welfare | Past |
Accepting new patients |
Locations
49725 County 83
Staples, MN 56479
Phone (218) 894-1033
Interoperability endpoints
- mellenson654828@direct.ochin.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Women's Health Nurse Practitioner | 363LW0102X | 12090 | MN | Yes |
Addresses
Primary practice location
49725 County 83
Staples, MN 56479-5280
Mailing address
49725 County 83
Staples, MN 56479-5280
Phone (218) 894-1515
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 518853900 | Medicaid | MN |
Other providers in Staples, MN
- Kelsey Mae Dockendorf
- Seth Alan Dokken
- Karen Lynn Dornbusch
- Constance L Dubois
- Anna Corinne Ehnstrom
- Jody Ellingson
- Kirstina Emans
- Essentially Life LLC
- Essilor Laboratories of America, Inc
- Jesse Fenstermacher
All providers in Staples, MN · Women's Health Nurse Practitioner in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 23, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.