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General NPI Number Information
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NPI Number | 1033002068
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Entity Type | Individual
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Provider Name | SANDRA LYNN KOELLER REGISTERED NURSE
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Gender | Female
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Dates
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Enumeration Date | 05/29/2025
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Last Update Date | 08/17/2026
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Provider Practice Location Address
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Address Line | E3384 COUNTY RD N
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City | DE SOTO
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State | WI
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Zip | 54624-8109
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Country | US
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Telephone | 207-298-0866
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Fax |
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Provider Business Mailing Address
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Address Line | E3384 COUNTY RD N
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City | DE SOTO
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State | WI
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Zip | 54624-8109
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Country | US
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Telephone | 207-298-0866
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 121847-30
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 1396043
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License Number State | MN
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