Healthcare Provider Details

I. General information

NPI: 1295217727
Provider Name (Legal Business Name): MICHELLE LEE MCCOY CNOR,RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2018
Last Update Date: 09/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 N 1ST ST
SPRINGFIELD IL
62702-3749
US

IV. Provider business mailing address

1025 S 6TH ST
SPRINGFIELD IL
62703-2499
US

V. Phone/Fax

Practice location:
  • Phone: 217-528-7541
  • Fax: 217-541-7683
Mailing address:
  • Phone: 217-528-7541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number041338928
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: