Provider Demographics
NPI:1700869922
Name:KOCH, JOHNNIE MAE (RNFA)
Entity Type:Individual
Prefix:MS
First Name:JOHNNIE
Middle Name:MAE
Last Name:KOCH
Suffix:
Gender:F
Credentials:RNFA
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Other - Credentials:
Mailing Address - Street 1:LANDSTUHL REGIONAL MEDICAL CENTER
Mailing Address - Street 2:ATTN: MCEUL-DCCS (CREDENTIALS), CMR 402
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09180
Mailing Address - Country:DE
Mailing Address - Phone:01149637-186-8839
Mailing Address - Fax:01149637-186-6133
Practice Address - Street 1:LANDSTUHL REGIONAL MEDICAL CENTER
Practice Address - Street 2:SPINE & NEUROSURGERY
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09180
Practice Address - Country:DE
Practice Address - Phone:01149637-186-6308
Practice Address - Fax:01149637-186-6995
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-22
Last Update Date:2022-07-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0001128600163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical