Provider Demographics
NPI:1093037855
Name:KOELLER, ERIN MICHAEL (LPN)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:MICHAEL
Last Name:KOELLER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4036 AMBER LN
Mailing Address - Street 2:
Mailing Address - City:WEST ALEXANDRIA
Mailing Address - State:OH
Mailing Address - Zip Code:45381-9341
Mailing Address - Country:US
Mailing Address - Phone:937-733-3650
Mailing Address - Fax:
Practice Address - Street 1:4036 AMBER LN
Practice Address - Street 2:
Practice Address - City:WEST ALEXANDRIA
Practice Address - State:OH
Practice Address - Zip Code:45381-9341
Practice Address - Country:US
Practice Address - Phone:937-733-3650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-22
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH114558164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse