Family Advocacy Center of Northern Minnesota

Primary specialty

SpecialistTaxonomy code 174400000X

License

R1031751 Issued in MN

Legal business name

FAMILY ADVOCACY CENTER OF NORTHERN MINNESOTA

Practice address

4211 Minnkota Ave NW
Bemidji, MN 56601-6078

Phone

(218) 444-6127

Fax

(218) 444-6129

NPI assigned

Nov 14, 2006

Organization subpart

No

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

Authorized official

Name

Sherry L Ellefson, NP

Title

Director

Phone

(218) 333-6011

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1163462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1568534576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 ANNE ST NW",
            "city": "BEMIDJI",
            "state": "MN",
            "postal_code": "566015103",
            "telephone_number": "218-333-6011",
            "fax_number": "218-333-6113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4211 MINNKOTA AVE NW",
            "city": "BEMIDJI",
            "state": "MN",
            "postal_code": "566016078",
            "telephone_number": "218-444-6127",
            "fax_number": "218-444-6129"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY ADVOCACY CENTER OF NORTHERN MINNESOTA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ELLEFSON",
        "authorized_official_first_name": "SHERRY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "218-333-6011",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "MN",
            "license": "R1031751",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Bemidji, MN
• Providers in Bemidji, MN by specialty
• Specialist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.