Individual
SUSAN ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PNP
Contact information
Practice address
1609 CEDAR ST, MUSCATINE, IA 52761-3426
(563) 263-0122
(563) 263-0520
Mailing address
2048 MISSISSIPPI VIEW DR, MUSCATINE, IA 52761-8326
(563) 264-1990
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
C-079193
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
22315
BLUE CROSS BLUE SHIELD
IA
Enumeration date
02/02/2007
Last updated
07/08/2007
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