Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 1078 | WI |
N | 207VG0400X | Gynecologist | 1078 | WI |
N | 207VX0000X | Obstetrician | 1078 | WI |
N | 363L00000X | Nurse Practitioner | 1078 | WI |
NPI | 1366550436 |
---|---|
Provider Name | Susan F Koehler |
First Address | Manitowoc, WI 54220-6845 |
Second Address | Manitowoc, WI 54220-6845 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
43920200 | (05) | WI |
S80426 | (02) |