Healthcare Provider Details

I. General information

NPI: 1417149808
Provider Name (Legal Business Name): MEGAN JOYCE KOEHLER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MEGAN JOYCE LUBACH

II. Dates (important events)

Enumeration Date: 08/09/2007
Last Update Date: 03/16/2025
Certification Date: 03/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N3270 COUNTY ROAD T
NEW HOLSTEIN WI
53061-9720
US

IV. Provider business mailing address

N3270 COUNTY ROAD T
NEW HOLSTEIN WI
53061-9720
US

V. Phone/Fax

Practice location:
  • Phone: 920-698-0025
  • Fax:
Mailing address:
  • Phone: 920-698-0025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number158262-030
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: