Healthcare Provider Details

I. General information

NPI: 1891231866
Provider Name (Legal Business Name): KAREN MARIE KOELLER NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2017
Last Update Date: 01/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE HOAG DRIVE, BLDG 41, 3RD FLOOR HOAG MEDICAL ONCOLOGY CLINIC
NEWPORT BEACH CA
92663-4162
US

IV. Provider business mailing address

ONE HOAG DRIVE, BLDG 41, 3RD FLOOR HOAG MEDICAL ONCOLOGY CLINIC
NEWPORT BEACH CA
92663-4162
US

V. Phone/Fax

Practice location:
  • Phone: 949-764-6130
  • Fax:
Mailing address:
  • Phone: 949-764-6130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number95004521
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95004521
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: