Provider Demographics
NPI:1811625122
Name:KOCH, ALEXANDRA CHRISTINE (APNP)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:CHRISTINE
Last Name:KOCH
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:CHRISTINE
Other - Last Name:HETZER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-955-1700
Mailing Address - Fax:414-955-0072
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-955-1700
Practice Address - Fax:414-955-0072
Is Sole Proprietor?:No
Enumeration Date:2022-08-13
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI196588-30163W00000X
WI13118-33363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse