Healthcare Provider Details

I. General information

NPI: 1447922927
Provider Name (Legal Business Name): VICKI M KOCH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2021
Last Update Date: 10/02/2021
Certification Date: 10/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 HUNTER LN
CAMP HILL PA
17011-2499
US

IV. Provider business mailing address

30 HUNTER LN
CAMP HILL PA
17011-2499
US

V. Phone/Fax

Practice location:
  • Phone: 800-748-3243
  • Fax:
Mailing address:
  • Phone: 800-748-3243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number311955
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: