Amanda Ellingson, RN

Primary specialty

Psychiatric/Mental Health Registered NurseTaxonomy code 163WP0808X

License

R34720 Issued in ND

Practice address

2701 12TH Ave S
Fargo, ND 58103-8753

Phone

(701) 451-4900

NPI assigned

Oct 3, 2019

Last updated

Oct 3, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Village Family Service Center

  dba The Village Family Service Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Fargo, ND
  • NPI 1568492353
  NPD
• Village Family Service Center

  dba The Village Family Service Center

  • Substance Abuse Rehabilitation Facility
  • Fargo, ND
  • NPI 1952679318
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1570060800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1570060800000",
    "number": "1548801228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2701 12TH AVE S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581038753",
            "telephone_number": "701-451-4900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2701 12TH AVE S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581038753",
            "telephone_number": "701-451-4900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLINGSON",
        "first_name": "AMANDA",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-10-03",
        "last_updated": "2019-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "ND",
            "license": "R34720",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ND REGISTERED NURSE LICENSE",
            "identifier": "R34720",
            "state": "ND"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "aellingson@thevillagefamily.org",
            "affiliation": "N",
            "endpointDescription": "secured work email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2701 12th Ave S",
            "city": "Fargo",
            "state": "ND",
            "country_code": "US",
            "postal_code": "581038753",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Elim Homes, Inc. (Elim Rehab & Care Center)
• Elite Homecare LLP
• Elite Therapeutic Massage LLC
• Donna Ellenson, PA
• Donna Durand Ellig, MS OTRL
• Elizabeth Ellingson, LAPC
• Hailey Ellingson, PSYD
• Lori Ellingson, FNP
• Rebecca Anne Ellingson
• Summer Joy Ellingson, APRN, CNP

• Psychiatric/Mental Health Registered Nurse in Fargo, ND
• Providers in Fargo, ND by specialty
• Psychiatric/Mental Health Registered Nurse in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.