Provider Demographics
NPI:1558356113
Name:KOCH, MARISSA (WHNP, RNC)
Entity Type:Individual
Prefix:MS
First Name:MARISSA
Middle Name:
Last Name:KOCH
Suffix:
Gender:F
Credentials:WHNP, RNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7865 GODOLPHIN DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22153-3308
Mailing Address - Country:US
Mailing Address - Phone:703-455-3536
Mailing Address - Fax:
Practice Address - Street 1:238 BROOKLEY AVE SW
Practice Address - Street 2:
Practice Address - City:BOLLING AFB
Practice Address - State:DC
Practice Address - Zip Code:20032
Practice Address - Country:US
Practice Address - Phone:703-681-6196
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA418533363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health