Provider Demographics
NPI:1861672339
Name:KOEHN, ALEXANDRA MAE (NP)
Entity Type:Individual
Prefix:MRS
First Name:ALEXANDRA
Middle Name:MAE
Last Name:KOEHN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6331 GLENWAY AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45211-6301
Mailing Address - Country:US
Mailing Address - Phone:513-389-1400
Mailing Address - Fax:513-619-8713
Practice Address - Street 1:6331 GLENWAY AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45211-6301
Practice Address - Country:US
Practice Address - Phone:513-389-1400
Practice Address - Fax:513-619-8713
Is Sole Proprietor?:No
Enumeration Date:2007-11-13
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH09759363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH09759OtherNP LICENSE