Healthcare Provider Details

I. General information

NPI: 1699850305
Provider Name (Legal Business Name): LYNN MOUSEL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 05/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 PORTER AVE
DES MOINES IA
50315-7235
US

IV. Provider business mailing address

205 E PARK AVE
ANACONDA MT
59711-2340
US

V. Phone/Fax

Practice location:
  • Phone: 515-285-6781
  • Fax:
Mailing address:
  • Phone: 406-563-8117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number12647
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: