| Doctor Name: | MS. MARISSA KOCH |
| NPI Number: | 1558356113 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | WHNP, RNC |
| License Number: | 418533 |
| Business Practice Address: | 238 Brookley Ave Sw Bolling Afb, DC - 20032 |
| Business Phone Number: | 7036816196 |
| Business Fax Number: | |
| Mailing Address: | 7865 Godolphin Dr, SPRINGFIELD |
| State: | VA |
| Postal Code: | 221533308 |
| Phone Number: | 7034553536 |
| Fax Number: | |
| NPI Enumeration Date: | 09/20/2005 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LW0102X |
| License Number: | 418533 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Women's Health |
| Taxonomy Definition: | |