Provider Demographics
NPI:1275791733
Name:KOELSCH, JAMES EDWARD (RN)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:EDWARD
Last Name:KOELSCH
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:867 51ST ST
Mailing Address - Street 2:
Mailing Address - City:CALEDONIA
Mailing Address - State:WI
Mailing Address - Zip Code:53108-9781
Mailing Address - Country:US
Mailing Address - Phone:262-835-4931
Mailing Address - Fax:
Practice Address - Street 1:867 51ST ST
Practice Address - Street 2:
Practice Address - City:CALEDONIA
Practice Address - State:WI
Practice Address - Zip Code:53108-9781
Practice Address - Country:US
Practice Address - Phone:262-835-4931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-30
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI112588-030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse