Provider Demographics
NPI:1821034281
Name:KOCH, ANDREA E (WHNP)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:E
Last Name:KOCH
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:BROCKBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10700 HIGHWAY 55
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-6100
Mailing Address - Country:US
Mailing Address - Phone:952-213-2144
Mailing Address - Fax:
Practice Address - Street 1:10700 HIGHWAY 55
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-6100
Practice Address - Country:US
Practice Address - Phone:952-213-2144
Practice Address - Fax:952-213-2184
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1697315363LW0102X
MN2910363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN861404100Medicaid
MN861404100Medicaid