Healthcare Provider Details

I. General information

NPI: 1871805275
Provider Name (Legal Business Name): TERRA D COTTRILL APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2010
Last Update Date: 09/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 W SPRINGFIELD RD
ARCOLA IL
61910-1202
US

IV. Provider business mailing address

1005 HEALTH CENTER DR STE 201
MATTOON IL
61938-4693
US

V. Phone/Fax

Practice location:
  • Phone: 217-268-4444
  • Fax: 217-268-3098
Mailing address:
  • Phone: 217-238-6055
  • Fax: 217-258-2216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209008202
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: