Healthcare Provider Details

I. General information

NPI: 1245340421
Provider Name (Legal Business Name): CHRISTINE COERVER ASSIA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTINE LYNN COERVER MD

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 05/27/2021
Certification Date: 05/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 N ROCKTON AVE
ROCKFORD IL
61103-3655
US

IV. Provider business mailing address

2254 MILITARY RD
ARLINGTON VA
22207-3958
US

V. Phone/Fax

Practice location:
  • Phone: 815-971-3333
  • Fax:
Mailing address:
  • Phone: 571-970-8733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036091024
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: