Provider Demographics
NPI:1326231465
Name:KOELEWYN, ROBERT S (LABORATORY DIRECTOR)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:S
Last Name:KOELEWYN
Suffix:
Gender:F
Credentials:LABORATORY DIRECTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:330 CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-4375
Mailing Address - Country:US
Mailing Address - Phone:559-584-1401
Mailing Address - Fax:559-583-8178
Practice Address - Street 1:330 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-4375
Practice Address - Country:US
Practice Address - Phone:559-584-1401
Practice Address - Fax:559-583-8178
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physician