Healthcare Provider Details

I. General information

NPI: 1134125594
Provider Name (Legal Business Name): MARGARET JULIE KOEPPING RN-BC, MN, F.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 12/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6203 AGENCY LOOP ROAD
WELLPINIT WA
99040-0357
US

IV. Provider business mailing address

PO BOX 357
WELLPINIT WA
99040-0357
US

V. Phone/Fax

Practice location:
  • Phone: 509-258-4517
  • Fax: 509-258-6757
Mailing address:
  • Phone: 509-258-4517
  • Fax: 509-258-6757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00089058
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP30004280
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number200150019NP FNP PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: