Provider Demographics
NPI:1003238668
Name:MOUSER, ELLEN EDITH (PMHNP)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:EDITH
Last Name:MOUSER
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 S J ST
Mailing Address - Street 2:
Mailing Address - City:LAKEVIEW
Mailing Address - State:OR
Mailing Address - Zip Code:97630-1623
Mailing Address - Country:US
Mailing Address - Phone:541-947-3366
Mailing Address - Fax:541-947-4404
Practice Address - Street 1:270 MAPLE SUMMIT RD
Practice Address - Street 2:
Practice Address - City:JERSEYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62052
Practice Address - Country:US
Practice Address - Phone:618-639-9952
Practice Address - Fax:618-639-9955
Is Sole Proprietor?:No
Enumeration Date:2014-01-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209011105363LP0808X
OR201905482NP-PP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2018080836OtherANCC PSYCHIATRIC-MENTAL HEALTH NURSE PRACTITIONER PMHNP-BC
OR201905482NP-PPOtherLICENSE