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General NPI Number Information
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NPI Number | 1477468601
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Entity Type | Individual
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Provider Name | ANGIE MARIE KOELLE BSN, RN
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Gender | Female
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Dates
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Enumeration Date | 08/13/2026
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Last Update Date | 08/13/2026
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Provider Practice Location Address
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Address Line | 820 E MOUNTAIN VIEW ST
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City | BARSTOW
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State | CA
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Zip | 92311-3004
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Country | US
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Telephone | 760-957-3323
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Fax |
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Provider Business Mailing Address
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Address Line | 14180 CREE RD
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City | APPLE VALLEY
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State | CA
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Zip | 92307-5765
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Country | US
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Telephone | 760-220-0120
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 95165658
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License Number State | CA
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