Provider Demographics
NPI:1316190556
Name:KOCH, ANITA R (RN CNS)
Entity Type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:R
Last Name:KOCH
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Gender:F
Credentials:RN CNS
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Mailing Address - Street 1:4135 BOARDMAN CANFIELD RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-9803
Mailing Address - Country:US
Mailing Address - Phone:330-286-5330
Mailing Address - Fax:330-286-5396
Practice Address - Street 1:7067 TIFFANY BLVD
Practice Address - Street 2:SUITE 230
Practice Address - City:POLAND
Practice Address - State:OH
Practice Address - Zip Code:44514-1993
Practice Address - Country:US
Practice Address - Phone:330-758-2748
Practice Address - Fax:330-758-3282
Is Sole Proprietor?:No
Enumeration Date:2008-10-31
Last Update Date:2017-06-22
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Provider Licenses
StateLicense IDTaxonomies
OHRN. 226436163W00000X
OHNS09826364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000955776OtherANTHEM BSBS
OH2916518Medicaid
OHH155462OtherMEDICARE PTAN