MEDICARE: DAWN COTTER CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	209005599	IL
2	163W00000X	Registered Nurse	041309587	IL

General Provider Information

NPI Number	:	1982672317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAWN COTTER CRNA

Provider Business Mailing Address
First Line	:	611 W PARK ST
Second Line	:	FAPC
City	:	URBANA
State	:	IL
Zip	:	61801
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1302 FRANKLIN AVE
Second Line	:
City	:	NORMAL
State	:	IL
Zip	:	61761-3551
Country	:	US
Telephone Number	:	309-268-5867
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2006
Last Update Date	:	05/13/2025

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