Individual
REBECCA LYNN KOO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1919 E THOMAS RD, PHOENIX, AZ 85016-7710
(602) 546-1900
(602) 546-1918
Mailing address
3200 E CAMELBACK RD, STE 250, PHOENIX, AZ 85018-2327
(602) 933-1813
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
177089
WI
363LP0200X
Pediatric Nurse Practitioner
209005271
IL
363LP2300X
Primary Care Nurse Practitioner
Primary
AP4842
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1114122918
—
WI
Enumeration date
06/20/2007
Last updated
10/30/2017
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