Provider Demographics
NPI:1598225344
Name:TOWNSEND, ELISSA (APN)
Entity Type:Individual
Prefix:MRS
First Name:ELISSA
Middle Name:
Last Name:TOWNSEND
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1029 N 8TH STREET
Mailing Address - Street 2:
Mailing Address - City:VANDALLA
Mailing Address - State:IL
Mailing Address - Zip Code:62471-1238
Mailing Address - Country:US
Mailing Address - Phone:618-283-4469
Mailing Address - Fax:618-283-4797
Practice Address - Street 1:1029 N 8TH STREET
Practice Address - Street 2:
Practice Address - City:VANDALLA
Practice Address - State:IL
Practice Address - Zip Code:62471-1238
Practice Address - Country:US
Practice Address - Phone:618-283-4469
Practice Address - Fax:618-283-4797
Is Sole Proprietor?:No
Enumeration Date:2019-03-20
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209018984363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner