1588705602 NPI number — DENISE EVIE KOEHN WHNP

Table of content: DENISE EVIE KOEHN WHNP (NPI 1588705602)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588705602 NPI number — DENISE EVIE KOEHN WHNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOEHN
Provider First Name:
DENISE
Provider Middle Name:
EVIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
WHNP
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:
1588705602
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/29/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
275 FLODEN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GWINN
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49841-8750
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
906-249-4368
Provider Business Mailing Address Fax Number:
906-249-4368

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
MARQUETTE COUNTY HEALTH DEPT.
Provider Second Line Business Practice Location Address:
184 HWY 41 EAST
Provider Business Practice Location Address City Name:
NEGAUNEE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49866
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
906-315-2630
Provider Business Practice Location Address Fax Number:
906-475-4435
Provider Enumeration Date:
02/09/2007

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: 363LW0102X , with the licence number:  4704153224 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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