Individual
TERRY SOPER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
102 W KENWOOD AVE, SUITE 120, DECATUR, IL 62526-4368
(217) 876-2199
(217) 876-2196
Mailing address
102 W KENWOOD AVE, SUITE 120, DECATUR, IL 62526-4368
(217) 876-2199
(217) 876-2196
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209008819
IL
Other
Enumeration date
05/31/2011
Last updated
05/31/2011
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