Provider Demographics
NPI:1649809617
Name:COEURVIE, SHARRON RACHEL (RN)
Entity type:Individual
Prefix:
First Name:SHARRON
Middle Name:RACHEL
Last Name:COEURVIE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 E MAIN ST STE 511
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-3649
Mailing Address - Country:US
Mailing Address - Phone:217-355-3507
Mailing Address - Fax:
Practice Address - Street 1:44 E MAIN ST STE 511
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-3649
Practice Address - Country:US
Practice Address - Phone:217-355-3507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-02
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH166595163WG0000X, 163WM1400X, 163WP0808X
IL041230252163WP0807X, 163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral PracticeGroup - Multi-Specialty
No163WM1400XNursing Service ProvidersRegistered NurseNurse Massage Therapist (NMT)Group - Multi-Specialty
No163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health