Healthcare Provider Details

I. General information

NPI: 1679594014
Provider Name (Legal Business Name): THERESE NANCY COHA APN, CWOCN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 N CHILDRENS PLZ # 63
CHICAGO IL
60614-3363
US

IV. Provider business mailing address

411 S COTTAGE HILL AVE
ELMHURST IL
60126-3920
US

V. Phone/Fax

Practice location:
  • Phone: 773-880-8198
  • Fax:
Mailing address:
  • Phone: 630-833-6380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0200X
TaxonomyPediatric Clinical Nurse Specialist
License Number209-003252
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: