Provider Demographics
NPI:1740553890
Name:KOEHNKE, DEBRA SCHLOUGH (RN)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:SCHLOUGH
Last Name:KOEHNKE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:ANN
Other - Last Name:SCHLOUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:619 KESSLER DR
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-4113
Mailing Address - Country:US
Mailing Address - Phone:920-729-9536
Mailing Address - Fax:
Practice Address - Street 1:1506 S ONEIDA ST
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54915-1305
Practice Address - Country:US
Practice Address - Phone:920-738-2558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-21
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI128939-030163WC3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC3500XNursing Service ProvidersRegistered NurseCardiac Rehabilitation