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Individual

MRS. ANITA R. KOCH

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
RN CNS

Contact information

Practice address
7067 TIFFANY BLVD, SUITE 230, POLAND, OH 44514-1993
(330) 758-2748
(330) 758-3282
Mailing address
4135 BOARDMAN CANFIELD RD, SUITE 101, CANFIELD, OH 44406-9803
(330) 286-5330
(330) 286-5396

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN. 226436
OH
364SA2200X
Adult Health Clinical Nurse Specialist
Primary
NS09826
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000955776
ANTHEM BSBS
OH
05
2916518
OH
01
H155462
MEDICARE PTAN
OH
Enumeration date
10/31/2008
Last updated
06/22/2017
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