Provider Demographics
NPI:1194044602
Name:KOCH, CHARMAINE MARIE (REGISTERED NURSE)
Entity Type:Individual
Prefix:MS
First Name:CHARMAINE
Middle Name:MARIE
Last Name:KOCH
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 DAKOTA ST
Mailing Address - Street 2:APT 11
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14216-2736
Mailing Address - Country:US
Mailing Address - Phone:716-860-3909
Mailing Address - Fax:
Practice Address - Street 1:38 DAKOTA ST
Practice Address - Street 2:APT 11
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14216-2736
Practice Address - Country:US
Practice Address - Phone:716-860-3909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-24
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY494049163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse