Provider Demographics
NPI:1912400326
Name:KOEPP, DOREEN (RN)
Entity Type:Individual
Prefix:
First Name:DOREEN
Middle Name:
Last Name:KOEPP
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 PUMPKIN LN
Mailing Address - Street 2:
Mailing Address - City:CLINTON CORNERS
Mailing Address - State:NY
Mailing Address - Zip Code:12514-2812
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:915 PUMPKIN LN
Practice Address - Street 2:
Practice Address - City:CLINTON CORNERS
Practice Address - State:NY
Practice Address - Zip Code:12514-2812
Practice Address - Country:US
Practice Address - Phone:845-797-2195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-12
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY512720-1163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics