Healthcare Provider Details

I. General information

NPI: 1598847584
Provider Name (Legal Business Name): PATRICIA NORRIS-KOEPCKE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PATRICIA NORRIS

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 09/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2777 LONG BEACH BLVD SUITE 200
LONG BEACH CA
90806-1571
US

IV. Provider business mailing address

PO BOX 10818
SAN BERNARDINO CA
92423-0818
US

V. Phone/Fax

Practice location:
  • Phone: 562-426-9661
  • Fax: 562-426-4227
Mailing address:
  • Phone: 909-382-0201
  • Fax: 909-382-0210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number2149
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: