Healthcare Provider Details

I. General information

NPI: 1902912314
Provider Name (Legal Business Name): NOELLE R. COPE APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 08/23/2024
Certification Date: 08/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 STONEGATE DR
CHARLESTON IL
61920-7884
US

IV. Provider business mailing address

21 STONEGATE DR
CHARLESTON IL
61920-7884
US

V. Phone/Fax

Practice location:
  • Phone: 217-258-2525
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209-002270
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: