Provider Demographics
NPI:1508956616
Name:MCCOY, DIANA LOU (DNP DOCTOR OF NURSIN)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:LOU
Last Name:MCCOY
Suffix:
Gender:F
Credentials:DNP DOCTOR OF NURSIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5409 RUDGATE COURT
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61114-7705
Mailing Address - Country:US
Mailing Address - Phone:815-877-1727
Mailing Address - Fax:
Practice Address - Street 1:2902 MCFARLAND RD
Practice Address - Street 2:SUITE 202
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-6801
Practice Address - Country:US
Practice Address - Phone:815-316-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209004872364S00000X
WI0000467033364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist