Provider Demographics
NPI:1134501166
Name:KOCH, CORA (BSN, RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:CORA
Middle Name:
Last Name:KOCH
Suffix:
Gender:F
Credentials:BSN, RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3221 SE MAGNOLIA LN
Mailing Address - Street 2:
Mailing Address - City:TECUMSEH
Mailing Address - State:KS
Mailing Address - Zip Code:66542-9599
Mailing Address - Country:US
Mailing Address - Phone:785-213-8231
Mailing Address - Fax:
Practice Address - Street 1:3221 SE MAGNOLIA LN
Practice Address - Street 2:
Practice Address - City:TECUMSEH
Practice Address - State:KS
Practice Address - Zip Code:66542-9599
Practice Address - Country:US
Practice Address - Phone:785-213-8231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-25
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-96665-011163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant