Provider Demographics
NPI:1699855007
Name:COLLOPY, JANET L
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:L
Last Name:COLLOPY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3315 N SEMINARY ST
Mailing Address - Street 2:
Mailing Address - City:GALESBURG
Mailing Address - State:IL
Mailing Address - Zip Code:61401-1251
Mailing Address - Country:US
Mailing Address - Phone:309-344-1000
Mailing Address - Fax:309-344-2405
Practice Address - Street 1:3315 N SEMINARY ST
Practice Address - Street 2:
Practice Address - City:GALESBURG
Practice Address - State:IL
Practice Address - Zip Code:61401
Practice Address - Country:US
Practice Address - Phone:309-344-1000
Practice Address - Fax:309-344-2405
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041155451/209000357363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK36438Medicare ID - Type UnspecifiedINDIVIDUAL #
ILCB6569Medicare ID - Type UnspecifiedRR GROUP #
IL352520Medicare ID - Type UnspecifiedINDIVIDUAL #
ILR56507Medicare UPIN
IL833610Medicare ID - Type UnspecifiedGROUP #