Provider Demographics
NPI:1659627438
Name:KOCH, ALLISON MARIE
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:MARIE
Last Name:KOCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:MARIE
Other - Last Name:DRAKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11 PINECREST ROAD
Mailing Address - Street 2:
Mailing Address - City:WHITESBORO
Mailing Address - State:NY
Mailing Address - Zip Code:13492
Mailing Address - Country:US
Mailing Address - Phone:315-542-5629
Mailing Address - Fax:
Practice Address - Street 1:11 PINECREST ROAD
Practice Address - Street 2:
Practice Address - City:WHITESBORO
Practice Address - State:NY
Practice Address - Zip Code:13492
Practice Address - Country:US
Practice Address - Phone:315-542-5629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-30
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10307876164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse