Healthcare Provider Details

I. General information

NPI: 1629069398
Provider Name (Legal Business Name): WINIFRED GAIL KOEHLER WHCNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 09/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5955 ZEAMER AVE
ELMENDORF AFB AK
99506-3702
US

IV. Provider business mailing address

5955 ZEAMER AVE
ELMENDORF AFB AK
99506-3702
US

V. Phone/Fax

Practice location:
  • Phone: 907-580-1360
  • Fax:
Mailing address:
  • Phone: 907-580-1360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAP2060
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: