Active NPI
Elisabeth Rose Mudd
- Student in an Organized Health Care Education/Training Program
- Edwardsville, IL
National Provider Identifier
1912834334
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- License
- 39
- Practice address
- 1 Hairpin Drive
Edwardsville, IL 62026-0001 - Phone
- (618) 650-3956
- NPI assigned
- May 7, 2026
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | 39 | IL | Primary |
Addresses
Primary practice location
1 Hairpin Drive
Edwardsville, IL 62026-0001
Mailing address
1 Hairpin Drive
Edwardsville, IL 62026-0001
Phone (618) 650-3956
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 39 | IL | MD | Student in an Organized Health Care Education/Training Program |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1778112000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1778112000000",
"number": "1912834334",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 HAIRPIN DRIVE",
"city": "EDWARDSVILLE",
"state": "IL",
"postal_code": "620260001",
"telephone_number": "618-650-3956"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 HAIRPIN DRIVE",
"city": "EDWARDSVILLE",
"state": "IL",
"postal_code": "620260001",
"telephone_number": "618-650-3956"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MUDD",
"first_name": "ELISABETH",
"middle_name": "ROSE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2026-05-07",
"last_updated": "2026-05-07",
"certification_date": "2026-05-07",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "IL",
"license": "39",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Edwardsville, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.