Provider Demographics
NPI:1609979772
Name:KOELZER, DIAN FORRESTER (FNP)
Entity Type:Individual
Prefix:
First Name:DIAN
Middle Name:FORRESTER
Last Name:KOELZER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2155 IRON POINT RD
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-8707
Mailing Address - Country:US
Mailing Address - Phone:916-817-5659
Mailing Address - Fax:
Practice Address - Street 1:2155 IRON POINT RD
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-8707
Practice Address - Country:US
Practice Address - Phone:916-817-5659
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA499424363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily