Individual
NIKOLE LEE KOEHN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MATRG, ATC
Contact information
Practice address
2301 25TH ST S, FARGO, ND 58103
(701) 417-6000
Mailing address
4551 47TH AVE. SOUTH, APT. 103, FARGO, ND 58103
(701) 417-6000
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
2747
MN
174400000X
Specialist
697-15
ND
Other
Enumeration date
04/22/2016
Last updated
04/22/2016
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