Ellen Louise Zaeske, APRN, LICSW
Individual provider Active NPI Psychiatric/Mental Health Clinical Nurse Specialist · Fargo, ND
NPI 1346313616 · NPPES record last updated Aug 8, 2019
Key facts
- NPI
- 1346313616
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Clinical Nurse Specialist 364SP0808X
- License
- R20158 (ND)
- Practice address
- 1112 Nodak Dr S
Fargo, ND 58103-2366 - Phone
- (701) 232-6224
- Fax
- (701) 232-4687
- NPI assigned
- Nov 16, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Certified Nurse Specialist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6985 | MN | MD | Physical Therapist |
| R 124683-4 | MN | MD | Psychiatric/Mental Health Clinical Nurse Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Knowlton, O'Neill & Associates, P.C. | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 6985 | MN | |
| Psychiatric/Mental Health Clinical Nurse Specialist | 364SP0808X | R 124683-4 | MN | |
| Psychiatric/Mental Health Clinical Nurse Specialist | 364SP0808X | R20158 | ND | Yes |
Addresses
Primary practice location
1112 Nodak Dr S
Fargo, ND 58103-2366
Mailing address
1112 Nodak Dr S
Fargo, ND 58103-2366
Phone (701) 232-6224
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 536527900 | Medicaid | MN |
Other providers in Fargo, ND
- Sharleen Yuan
- Brandon Yurczyk
- Ywca Cass Clay
- Nicole Zabel
- Evan Lee Zacharias I
- Nathan Aaron Zaffke
- Madisyn Zahradka-Peterson
- Patricia Lynn Zahradka
- Zakaria Zaid
- Iqbal Zain Al Abideen
All providers in Fargo, ND · Psychiatric/Mental Health Clinical Nurse Specialist in North Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 8, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.