Active NPI
Judith Marie Ellerbusch, NP
- Specialist
- Roseville, MN
National Provider Identifier
1801163928
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- R846552
- Practice address
- 2277 Highway 36 W
Roseville, MN 55113-3804 - Phone
- (651) 631-0065
- NPI assigned
- Nov 17, 2011
- Last updated
- Nov 17, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | R846552 | MN | Primary |
Addresses
Primary practice location
2277 Highway 36 W
Roseville, MN 55113-3804
Mailing address
290 Cedar Cove LN
Owatonna, MN 55060-4200
Phone (507) 446-8055
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R846552 | MN | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1321488000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1321488000000",
"number": "1801163928",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "290 CEDAR COVE LN",
"city": "OWATONNA",
"state": "MN",
"postal_code": "550604200",
"telephone_number": "507-446-8055"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2277 HIGHWAY 36 W",
"city": "ROSEVILLE",
"state": "MN",
"postal_code": "551133804",
"telephone_number": "651-631-0065"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLERBUSCH",
"first_name": "JUDITH",
"middle_name": "MARIE",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-11-17",
"last_updated": "2011-11-17",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "MN",
"license": "R846552",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Roseville, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.