Healthcare Provider Details

I. General information

NPI: 1053673194
Provider Name (Legal Business Name): CASSANDRA LEE EUELL PMHNP-BC, MSN, R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2012
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 E STATE ST
ROCKFORD IL
61104-2315
US

IV. Provider business mailing address

2213 FARMDALE LN
FREEPORT IL
61032-2981
US

V. Phone/Fax

Practice location:
  • Phone: 779-696-4400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041.385931
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209032088
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: