Provider Demographics
NPI:1942481254
Name:KOCH, MONICA CHRISTINE (RN, BSN)
Entity Type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:CHRISTINE
Last Name:KOCH
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:CHRISTINE
Other - Last Name:BISSELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:615 W RIVERWOOD DR
Mailing Address - Street 2:APT #308
Mailing Address - City:OAK CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53154-8602
Mailing Address - Country:US
Mailing Address - Phone:414-243-4117
Mailing Address - Fax:
Practice Address - Street 1:615 W RIVERWOOD DR
Practice Address - Street 2:APT #308
Practice Address - City:OAK CREEK
Practice Address - State:WI
Practice Address - Zip Code:53154-8602
Practice Address - Country:US
Practice Address - Phone:414-243-4117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI35038000Medicaid