Healthcare Provider Details

I. General information

NPI: 1467475574
Provider Name (Legal Business Name): BARBARA J KOCH APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3021 VOYAGER DR
GREEN BAY WI
54311-8303
US

IV. Provider business mailing address

PO BOX 19070 PREVEA HEALTH
GREEN BAY WI
54307-9070
US

V. Phone/Fax

Practice location:
  • Phone: 920-496-4700
  • Fax: 920-496-4705
Mailing address:
  • Phone: 920-496-4700
  • Fax: 920-496-4705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number47243
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number846
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: