Provider Demographics
NPI:1013245513
Name:KOCH, MICHELLE MARIE (RN, PHN, BSN)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:MARIE
Last Name:KOCH
Suffix:
Gender:F
Credentials:RN, PHN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 N HOLCOMBE AVE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:LITCHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55355-2210
Mailing Address - Country:US
Mailing Address - Phone:320-693-5370
Mailing Address - Fax:320-693-5399
Practice Address - Street 1:114 N HOLCOMBE AVE
Practice Address - Street 2:SUITE 250
Practice Address - City:LITCHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55355-2210
Practice Address - Country:US
Practice Address - Phone:320-693-5370
Practice Address - Fax:320-693-5399
Is Sole Proprietor?:No
Enumeration Date:2009-11-23
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNZ986290946723163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse