Provider Demographics
NPI:1760123244
Name:KOEHLER, CHRISTINA MARY
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:MARY
Last Name:KOEHLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 N MICHIGAN AVE APT 411
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3825
Mailing Address - Country:US
Mailing Address - Phone:913-219-6204
Mailing Address - Fax:
Practice Address - Street 1:535 N MICHIGAN AVE APT 411
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3825
Practice Address - Country:US
Practice Address - Phone:913-219-6204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-06
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041429070163W00000X
IL209024380363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse