Healthcare Provider Details

I. General information

NPI: 1275771370
Provider Name (Legal Business Name): DANIELLE EMILY KOCH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2009
Last Update Date: 07/14/2020
Certification Date: 07/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5191 ROSEWOOD DR
TRAVERSE CITY MI
49685-9137
US

IV. Provider business mailing address

6227 FRANKFORT HWY
BENZONIA MI
49616-8632
US

V. Phone/Fax

Practice location:
  • Phone: 231-922-0667
  • Fax: 231-922-0668
Mailing address:
  • Phone: 231-882-9661
  • Fax: 231-882-9616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704237870
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: