Provider Demographics
NPI:1679594014
Name:COHA, THERESE NANCY (APN, CWOCN)
Entity Type:Individual
Prefix:MRS
First Name:THERESE
Middle Name:NANCY
Last Name:COHA
Suffix:
Gender:F
Credentials:APN, CWOCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 S COTTAGE HILL AVE
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-3920
Mailing Address - Country:US
Mailing Address - Phone:630-833-6380
Mailing Address - Fax:
Practice Address - Street 1:2300 N CHILDRENS PLZ # 63
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-3363
Practice Address - Country:US
Practice Address - Phone:773-880-8198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-003252364SP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPediatrics