Provider Demographics
NPI:1659558062
Name:KOEPP, JOANN CELESTE (RN)
Entity Type:Individual
Prefix:MRS
First Name:JOANN
Middle Name:CELESTE
Last Name:KOEPP
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68625 PEREZ RD STE 11A
Mailing Address - Street 2:
Mailing Address - City:CATHEDRAL CTY
Mailing Address - State:CA
Mailing Address - Zip Code:92234-7250
Mailing Address - Country:US
Mailing Address - Phone:760-773-6767
Mailing Address - Fax:
Practice Address - Street 1:68-625 PEREZ ROAD SUITE 11A
Practice Address - Street 2:
Practice Address - City:CATHEDRAL CITY
Practice Address - State:CA
Practice Address - Zip Code:92234
Practice Address - Country:US
Practice Address - Phone:760-773-6760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-28
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA586538163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health