Individual
DEBRA KOCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NNP
Contact information
Practice address
18101 OAKWOOD BLVD, DEPT OF NEONATOLOGY, DEARBORN, MI 48124-4089
(313) 593-7490
Mailing address
26901 BEAUMONT BLVD STE 3D, SOUTHFIELD, MI 48033-3849
Taxonomy
Speciality
Code
Description
License number
State
363LN0000X
Neonatal Nurse Practitioner
Primary
4704143015
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4704143015
LICENSE
MI
Enumeration date
02/06/2007
Last updated
07/21/2022
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