Provider Demographics
NPI:1801268081
Name:PRESCHER, ELLYN (NP)
Entity type:Individual
Prefix:
First Name:ELLYN
Middle Name:
Last Name:PRESCHER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ELLYN
Other - Middle Name:
Other - Last Name:JARVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:901 W WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:METAMORA
Mailing Address - State:IL
Mailing Address - Zip Code:61548-8637
Mailing Address - Country:US
Mailing Address - Phone:309-367-4144
Mailing Address - Fax:
Practice Address - Street 1:901 W WALNUT ST
Practice Address - Street 2:
Practice Address - City:METAMORA
Practice Address - State:IL
Practice Address - Zip Code:61548-8637
Practice Address - Country:US
Practice Address - Phone:309-367-4144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-27
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209013215363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner