Individual
JAN KOEBBE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
235 WEALTHY ST SE, GRAND RAPIDS, MI 49503-5247
(616) 840-8719
(616) 840-9637
Mailing address
235 WEALTHY ST SE, GRAND RAPIDS, MI 49503-5247
(616) 840-8719
(616) 840-9637
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704127360
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104545821
—
MI
01
—
JK127360
BLUE CROSS
MI
Enumeration date
08/30/2006
Last updated
02/20/2017
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