Provider Demographics
NPI:1821870791
Name:KOEHLER, MICHELLE LEE (DNP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LEE
Last Name:KOEHLER
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 RONALD DR
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:MA
Mailing Address - Zip Code:02777-2700
Mailing Address - Country:US
Mailing Address - Phone:508-243-0866
Mailing Address - Fax:
Practice Address - Street 1:440 SWANSEA MALL DR
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:MA
Practice Address - Zip Code:02777-4114
Practice Address - Country:US
Practice Address - Phone:508-675-5640
Practice Address - Fax:617-562-5313
Is Sole Proprietor?:No
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2303319363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health