Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LP0200X | Nurse Practitioner - Pediatrics | 6493 | WI |
N | 363LP0222X | Nurse Practitioner Pediatrics (Critical Care) | 209011077 | IL |
Y | 363LP0222X | Nurse Practitioner Pediatrics (Critical Care) | 6493 | WI |
NPI | 1033534169 |
---|---|
Provider Name | Drew Koeppl |
First Address | Green Bay, WI 54301-3526 |
Second Address | Milwaukee, WI 53226-4874 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2014 |
Last Update Date | 01/02/2019 |