Provider Demographics
NPI:1760460562
Name:KOESTNER, JULIA R (NP)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:R
Last Name:KOESTNER
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Gender:F
Credentials:NP
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Mailing Address - Street 1:451 HEALTH PARTKWAY
Mailing Address - Street 2:SUITE D
Mailing Address - City:PAW PAW
Mailing Address - State:MI
Mailing Address - Zip Code:49079
Mailing Address - Country:US
Mailing Address - Phone:269-655-3070
Mailing Address - Fax:269-655-0767
Practice Address - Street 1:451 HEALTH PKWY
Practice Address - Street 2:SUITE D
Practice Address - City:PAW PAW
Practice Address - State:MI
Practice Address - Zip Code:49079-8242
Practice Address - Country:US
Practice Address - Phone:269-655-3070
Practice Address - Fax:269-655-0767
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2020-11-13
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Provider Licenses
StateLicense IDTaxonomies
MI4704145804363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P03246Medicare UPIN
MIM97850011Medicare PIN