Individual
CHARLENE VELMA KOEPKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
10010 KENNERLY RD, SAINT LOUIS, MO 63128-2106
(636) 386-7222
(636) 386-7810
Mailing address
250 NE MULBERRY, SUITE 202, LEE'S SUMMIT, MO 64086-4533
(816) 389-4137
(816) 389-4140
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
094885
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
912719150
—
MO
Enumeration date
08/31/2006
Last updated
01/20/2010
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