Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Ellen Gustafson

Individual provider Physician Assistant · NPI 1417707563

Ellen Gustafson is a Physician Assistant in Minneapolis, Minnesota. Qualified in 2023, 3 years ago. Practices with Hennepin Healthcare System Inc, a 903-clinician group and accepts Medicare assignment. Licensed in Minnesota.

Years since qualifying
3
Licensed in
MN
In the registry since
2024
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Practice location Address checks out

701 Park Ave
Minneapolis, MN 55415-1623
Phone: (612) 873-6963
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 14847 (MN)

Record details

NPI number1417707563
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedMarch 22, 2024
Last updated in NPPESJune 4, 2024
Certification dateJune 4, 2024
Mailing address701 Park Ave, Minneapolis, MN 55415-1623

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Group practice Hennepin Healthcare System Inc — 903 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in Minneapolis