Healthcare Provider Details

I. General information

NPI: 1679343024
Provider Name (Legal Business Name): COURTNEY MUSSELMAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2024
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1836 S MACARTHUR BLVD
SPRINGFIELD IL
62704-4000
US

IV. Provider business mailing address

1836 S MACARTHUR BLVD
SPRINGFIELD IL
62704-4000
US

V. Phone/Fax

Practice location:
  • Phone: 217-789-1403
  • Fax: 217-525-1624
Mailing address:
  • Phone: 217-789-1403
  • Fax: 217-525-1624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209032663
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: