Provider Demographics
NPI:1457425639
Name:KOCH, JULIE ANN (NP)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:ANN
Last Name:KOCH
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 1:55 UNIVERSITY DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-2195
Mailing Address - Country:US
Mailing Address - Phone:219-464-5352
Mailing Address - Fax:219-464-5410
Practice Address - Street 1:55 UNIVERSITY DR
Practice Address - Street 2:SUITE 102
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-2195
Practice Address - Country:US
Practice Address - Phone:219-464-5352
Practice Address - Fax:219-464-5410
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000001363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000486432OtherANTHEM
IN200296630Medicaid
IN200296630Medicaid
P28843Medicare UPIN