Individual
DIANE M. KOCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
611 W. PARK ST., URBANA, IL 61801-2500
(217) 383-3140
(217) 383-4966
Mailing address
611 W. PARK ST., BWPC, URBANA, IL 61801-2500
(217) 383-6792
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209001138
IL
Other
Enumeration date
11/09/2006
Last updated
04/20/2015
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