Healthcare Provider Details

I. General information

NPI: 1609388545
Provider Name (Legal Business Name): RINA ELIZABETH CASLOW NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RINA ELIZABETH COCHRAN NP

II. Dates (important events)

Enumeration Date: 11/01/2017
Last Update Date: 09/14/2023
Certification Date: 09/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 S PARK AVE FL 2
HERRIN IL
62948-3602
US

IV. Provider business mailing address

1239 E MAIN ST
CARBONDALE IL
62901-3175
US

V. Phone/Fax

Practice location:
  • Phone: 618-988-6240
  • Fax:
Mailing address:
  • Phone: 618-457-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.016847
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209016847
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: