Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LP0200X | Nurse Practitioner - Pediatrics | 021080 23 02 | NH |
NPI | 1043383912 |
---|---|
Provider Name | Mrs. Joyce C Koerber |
First Address | Manchester, NH 03101-1308 |
Second Address | Manchester, NH 03101-1308 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30009888 | (05) | NH |