MEDICARE: ANITA COON FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	472301	OTHER	IL	HEALTHLINK
2	055805	OTHER	IL	HEALTH ALLIANCE
3	7215059	OTHER	IL	BCBS PPO

General Provider Information

NPI Number	:	1508880089
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANITA COON FNP

Provider Business Mailing Address
First Line	:	5100 RELIABLE PKWY
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60686-0001
Country	:	US
Telephone Number	:	309-672-4809
Fax Number	:

Provider Business Practice Location Address
First Line	:	815 MAIN ST
Second Line	:
City	:	PEORIA
State	:	IL
Zip	:	61602-1076
Country	:	US
Telephone Number	:	309-672-4977
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	07/08/2007

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