Provider Demographics
NPI:1801343157
Name:KOEHLER, LORI (CRNP)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:KOEHLER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 REYNOLDS ROAD,
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:CA
Mailing Address - Zip Code:96020
Mailing Address - Country:US
Mailing Address - Phone:106-130-4816
Mailing Address - Fax:
Practice Address - Street 1:199 REYNOLDS ROAD,
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:CA
Practice Address - Zip Code:96020-9602
Practice Address - Country:US
Practice Address - Phone:833-227-3743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-03
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95360029207Q00000X
MARN2307216363LF0000X
PASP015704363LF0000X
NV841731363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine