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General NPI Number Information
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NPI Number | 1053673194
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Entity Type | Individual
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Provider Name | CASSANDRA LEE EUELL PMHNP-BC, MSN, R.N.
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Gender | Female
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Dates
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Enumeration Date | 06/14/2012
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Last Update Date | 04/16/2025
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Provider Practice Location Address
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Address Line | 1401 E STATE ST
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City | ROCKFORD
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State | IL
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Zip | 61104-2315
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Country | US
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Telephone | 779-696-4400
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Fax |
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Provider Business Mailing Address
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Address Line | 2213 FARMDALE LN
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City | FREEPORT
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State | IL
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Zip | 61032-2981
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 041.385931
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 209032088
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License Number State | IL
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