1730460064 NPI number — MRS. LAUREEN C KOEHLER FNP

Table of content: MRS. LAUREEN C KOEHLER FNP (NPI 1730460064)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730460064 NPI number — MRS. LAUREEN C KOEHLER FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOEHLER
Provider First Name:
LAUREEN
Provider Middle Name:
C
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP
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:
1730460064
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/18/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
812 HUBS REC RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELHAVEN
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27810-9336
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-944-3690
Provider Business Mailing Address Fax Number:
252-359-5328

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
812 HUBS REC RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELHAVEN
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27810-9336
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-944-3690
Provider Business Practice Location Address Fax Number:
252-359-5328
Provider Enumeration Date:
08/31/2011

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: 363LF0000X , with the licence number:  5005288 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: 5005288 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 172YM . This is a "BCBS OF NC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1730460064 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1063184182 . This is a "ORGANIZATION NPI HOUSE CALLS, LLC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1730460064 . This is a "PERSONAL NPI NUMBER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: NC5807E . This is a "MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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