Healthcare Provider Details

I. General information

NPI: 1902860604
Provider Name (Legal Business Name): TERRI E KOEHLER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 04/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 S STATE ST BAYHEALTH MEDICAL CENTER
DOVER DE
19901-3530
US

IV. Provider business mailing address

640 S STATE ST
DOVER DE
19901-3530
US

V. Phone/Fax

Practice location:
  • Phone: 302-744-7088
  • Fax:
Mailing address:
  • Phone: 302-744-7088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberL60A00342
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: