Healthcare Provider Details

I. General information

NPI: 1063500429
Provider Name (Legal Business Name): SUSAN HENRY KOEGLER R.N., M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 S HUNTINGTON AVE VABHS (151MAV)
BOSTON MA
02130-4817
US

IV. Provider business mailing address

28 KATES GLN
PLYMOUTH MA
02360-8264
US

V. Phone/Fax

Practice location:
  • Phone: 857-364-4386
  • Fax: 857-364-6528
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number105786
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: