Individual
MATTHEW ANTHONY KOECKERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
2825 RANDOLPH RD, CHARLOTTE, NC 28211-1018
(704) 377-1647
(704) 358-8267
Mailing address
2080 W ARLINGTON BLVD STE B, GREENVILLE, NC 27834-3770
(252) 752-2140
(252) 689-6502
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
5671
NC
390200000X
Student in an Organized Health Care Education/Training Program
85106
WV
Other
Enumeration date
05/04/2017
Last updated
09/10/2021
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