Healthcare Provider Details

I. General information

NPI: 1508956616
Provider Name (Legal Business Name): DIANA LOU MCCOY DNP DOCTOR OF NURSIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 12/14/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2902 MCFARLAND RD SUITE 202
ROCKFORD IL
61107-6801
US

IV. Provider business mailing address

5409 RUDGATE COURT
ROCKFORD IL
61114-7705
US

V. Phone/Fax

Practice location:
  • Phone: 815-316-7300
  • Fax:
Mailing address:
  • Phone: 815-877-1727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number209004872
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number0000467033
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: