Provider Demographics
NPI:1649728874
Name:COELLO, EMILY (PA-C)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:COELLO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12255 S 80TH AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1284
Mailing Address - Country:US
Mailing Address - Phone:708-923-4400
Mailing Address - Fax:708-923-4421
Practice Address - Street 1:12255 S 80TH AVE STE 204
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1284
Practice Address - Country:US
Practice Address - Phone:708-923-4400
Practice Address - Fax:708-923-4421
Is Sole Proprietor?:No
Enumeration Date:2016-09-16
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085005972363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant