Doctor Name: | MS. NANCY ELLEN KOEHLER |
NPI Number: | 1164543716 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PA-C |
License Number: | PA14868 |
Business Practice Address: | 30201 Golden Lantern Suite B Laguna Niguel, CA - 926775979 |
Business Phone Number: | 9493731788 |
Business Fax Number: | |
Mailing Address: | 624 Via Espiritu, SAN CLEMENTE |
State: | CA |
Postal Code: | 926726002 |
Phone Number: | 9494927341 |
Fax Number: | |
NPI Enumeration Date: | 04/02/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | PA14868 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |