Healthcare Provider Details

I. General information

NPI: 1417445073
Provider Name (Legal Business Name): MEGAN MARIE KOEHN RDN, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2018
Last Update Date: 04/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1646 305TH ST
TAMA IA
52339-9698
US

IV. Provider business mailing address

717 LOCUST ST UNIT 812
DES MOINES IA
50309-3746
US

V. Phone/Fax

Practice location:
  • Phone: 641-484-4094
  • Fax:
Mailing address:
  • Phone: 563-599-9942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number091426
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: