Individual
DIANE ELAINE COLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
611 W PARK ST, URBANA, IL 61801-2529
(217) 383-3129
(217) 326-1550
Mailing address
611 W PARK ST, FAPC, URBANA, IL 61801
(217) 902-5292
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0010-05357
NC
363A00000X
Physician Assistant
Primary
085007740
IL
363A00000X
Physician Assistant
5601007645
MI
Other
Enumeration date
12/10/2014
Last updated
05/05/2021
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