Individual
MELISSA KOEHLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
572 LINCOLN AVE, SUITE #3, WINNETKA, IL 60093-2308
(847) 501-4040
Mailing address
2323 CENTRAL ST, APT 3W, EVANSTON, IL 60201-5736
(847) 826-0903
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041.415962
IL
363LP0200X
Pediatric Nurse Practitioner
Primary
209.011071
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
041.415962
RN LICENSE
IL
01
—
209.011071
APN LICENSE
IL
Enumeration date
12/31/2013
Last updated
12/31/2013
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