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General NPI Number Information
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NPI Number | 1801714373
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Entity Type | Individual
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Provider Name | ELYSSE RAE O'BRIEN
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Gender | Female
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Dates
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Enumeration Date | 07/09/2026
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Last Update Date | 07/09/2026
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Provider Practice Location Address
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Address Line | 600 N MAIN ST
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City | TAYLORVILLE
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State | IL
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Zip | 62568-1668
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Country | US
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Telephone | 217-287-8855
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Fax |
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Provider Business Mailing Address
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Address Line | 588 E 500 NORTH RD
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City | MORRISONVILLE
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State | IL
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Zip | 62546-6369
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Country | US
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Telephone | 217-827-6833
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 209036038
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License Number State | IL
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