1811161201 NPI number — MS. JULIE A KOEP RN

Table of content: MS. JULIE A KOEP RN (NPI 1811161201)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811161201 NPI number — MS. JULIE A KOEP RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOEP
Provider First Name:
JULIE
Provider Middle Name:
A
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811161201
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
501 4TH ST S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PRINCETON
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55371-2031
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-633-0648
Provider Business Mailing Address Fax Number:
763-633-7889

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
38 UNION ST N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MORA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55051-1326
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-679-1245
Provider Business Practice Location Address Fax Number:
763-552-1268
Provider Enumeration Date:
04/16/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  R 160754-1 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: R 160754-1 . This is a "RN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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