Provider Demographics
NPI:1811161201
Name:KOEP, JULIE A (RN)
Entity type:Individual
Prefix:MS
First Name:JULIE
Middle Name:A
Last Name:KOEP
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 4TH ST S
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:MN
Mailing Address - Zip Code:55371-2031
Mailing Address - Country:US
Mailing Address - Phone:763-633-0648
Mailing Address - Fax:763-633-7889
Practice Address - Street 1:38 UNION ST N
Practice Address - Street 2:
Practice Address - City:MORA
Practice Address - State:MN
Practice Address - Zip Code:55051-1326
Practice Address - Country:US
Practice Address - Phone:320-679-1245
Practice Address - Fax:763-552-1268
Is Sole Proprietor?:No
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 160754-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNR 160754-1OtherRN