| Doctor Name: | MS. ELLEN EDITH MOUSER |
| NPI Number: | 1003238668 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | ANP |
| License Number: | 209011105 |
| Business Practice Address: | 12 N 64th St Ste 5 Belleville, IL - 622233809 |
| Business Phone Number: | 6188774420 |
| Business Fax Number: | |
| Mailing Address: | 12 N 64th St Ste 5, BELLEVILLE |
| State: | IL |
| Postal Code: | 622233809 |
| Phone Number: | 6188774420 |
| Fax Number: | |
| NPI Enumeration Date: | 01/15/2014 |
| NPI Last Update Date: | 01/15/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0808X |
| License Number: | 209011105 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Psych/Mental Health |
| Taxonomy Definition: | |