Healthcare Provider Details

I. General information

NPI: 1124601695
Provider Name (Legal Business Name): DAWN ELIZABETH KOCH APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2021
Last Update Date: 05/03/2021
Certification Date: 04/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 E MAIN ST
MOUNT STERLING IL
62353-1378
US

IV. Provider business mailing address

521 E MAIN ST
MOUNT STERLING IL
62353-1378
US

V. Phone/Fax

Practice location:
  • Phone: 217-223-1200
  • Fax:
Mailing address:
  • Phone: 217-223-1200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209023160
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: