Individual
MR. NICHOLAS BRENT KOCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
AGPCNP-BC
Contact information
Practice address
150 E HURON ST STE 1101, CHICAGO, IL 60611-2948
(312) 741-8554
(312) 216-1779
Mailing address
150 E HURON ST STE 1101, CHICAGO, IL 60611-2948
(312) 741-8554
(312) 216-1779
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
209.028387
IL
363LP2300X
Primary Care Nurse Practitioner
Primary
209.028387
IL
Other
Enumeration date
10/05/2023
Last updated
11/23/2024
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