Individual
SUSAN ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
621 W MADRONE ST, ROSEBURG, OR 97470-3090
(541) 492-4550
(541) 492-4556
Mailing address
PO BOX 1121, ROSEBURG, OR 97470-0254
(541) 672-2691
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
202114835NP-PP
OR
Other
Enumeration date
02/26/2014
Last updated
09/29/2025
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