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General NPI Number Information
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NPI Number | 1063500429
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Entity Type | Individual
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Provider Name | SUSAN HENRY KOEGLER R.N., M.S.
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Gender | Female
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 150 S HUNTINGTON AVE VABHS (151MAV)
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City | BOSTON
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State | MA
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Zip | 02130-4817
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Country | US
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Telephone | 857-364-4386
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Fax | 857-364-6528
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Provider Business Mailing Address
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Address Line | 28 KATES GLN
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City | PLYMOUTH
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State | MA
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Zip | 02360-8264
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Country | US
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Telephone |
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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 | 163WX0200X
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Taxonomy Name | Oncology Registered Nurse
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License Number | 105786
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License Number State | MA
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