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Individual

LORA LEE E KOEPP

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PNP

Contact information

Practice address
5 W LAKE ST, MINNEAPOLIS, MN 55408-3117
(612) 545-9000
(612) 545-9049
Mailing address
701 PARK AVE, MINNEAPOLIS, MN 55415-1623
(612) 873-6005
(612) 630-8242

Taxonomy

Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
20000365
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
12-01355
MEDICA
MN
01
40D83KO
BLUE CROSS BLUE SHIELD
MN
05
887019500
MN
Enumeration date
06/07/2006
Last updated
11/28/2007
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