Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 201905482NP-PP | OR |
N | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 209011105 | IL |
NPI | 1003238668 |
---|---|
Provider Name | Ms. Ellen Edith Mouser |
First Address | Lakeview, OR 97630-1623 |
Second Address | Lakeview, OR 97630-1623 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2014 |
Last Update Date | 10/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2018080836 | ANCC PSYCHIATRIC-MENTAL HEALTH NURSE PRACTITIONER PMHNP-BC (01) | IL |
201905482NP-PP | LICENSE (01) | OR |