Healthcare Provider Details

I. General information

NPI: 1740553890
Provider Name (Legal Business Name): DEBRA SCHLOUGH KOEHNKE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEBRA ANN SCHLOUGH RN

II. Dates (important events)

Enumeration Date: 02/21/2012
Last Update Date: 02/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1506 S ONEIDA ST
APPLETON WI
54915-1305
US

IV. Provider business mailing address

619 KESSLER DR
NEENAH WI
54956-4113
US

V. Phone/Fax

Practice location:
  • Phone: 920-738-2558
  • Fax:
Mailing address:
  • Phone: 920-729-9536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC3500X
TaxonomyCardiac Rehabilitation Registered Nurse
License Number128939-030
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: