Provider Demographics
NPI:1467710046
Name:KOEHN, ERNESTINE MONICA (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:ERNESTINE
Middle Name:MONICA
Last Name:KOEHN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 E. NORTHWEST HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:MT. PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056
Mailing Address - Country:US
Mailing Address - Phone:847-867-7924
Mailing Address - Fax:773-752-1507
Practice Address - Street 1:800 E. NORTHWEST HIGHWAY
Practice Address - Street 2:
Practice Address - City:MT. PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056
Practice Address - Country:US
Practice Address - Phone:847-299-4952
Practice Address - Fax:847-299-4952
Is Sole Proprietor?:No
Enumeration Date:2012-05-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.009215363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily