Provider Demographics
NPI:1942074638
Name:KOEHLER, LEONOR
Entity Type:Individual
Prefix:
First Name:LEONOR
Middle Name:
Last Name:KOEHLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LEONOR
Other - Middle Name:
Other - Last Name:KOEHLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:5113 WHITMAN WAY APT 314
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-4625
Mailing Address - Country:US
Mailing Address - Phone:760-522-2231
Mailing Address - Fax:
Practice Address - Street 1:5113 WHITMAN WAY APT 314
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-4625
Practice Address - Country:US
Practice Address - Phone:760-522-2231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-13
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA578606163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty