Gavrilos, Terrah Koppie

Gavrilos, Terrah Koppie is an sole proprietor health care provider with primary practice located at 925 Sherwood Dr , Lake Bluff IL 60044-2203. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Pediatrics, Physician Assistants & Advanced Practice Nursing Providers / Family. Physician Assistants & Advanced Practice Nursing Providers / Family is her primary health care specialty. Gavrilos, Terrah Koppie can be contacted via phone (847) 234-1177.

Contact Information

Primary practice address
925 Sherwood Dr Lake Bluff IL 60044-2203
Phone: (847) 234-1177
Fax: (847) 234-1875
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Pediatrics 363LP0200X 209015215 Illinois
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 209015215 Illinois

Profile Details

NPI number 1396250346
LBN Legal business name Gavrilos, Terrah Koppie
Credentials APN, CNP
Entity Individual
Sole proprietor 1 Yes
Enumeration date Dec 12th, 2017
Last updated Jul 17th, 2024 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1396250346 NPPES
Illinois Other 309010634 APN CONTROLLED SUBSTANCE
Illinois Other 209105215 APN CONTROLLED SUBSTANCE
Illinois Other 041374819 APN CONTROLLED SUBSTANCE
Illinois MEDICAID 1396250346 APN CONTROLLED SUBSTANCE

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