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General NPI Number Information
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NPI Number | 1649736968
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Entity Type | Individual
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Provider Name | CARLA KOONS RN
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Gender | Female
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Dates
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Enumeration Date | 02/11/2019
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Last Update Date | 02/11/2019
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Provider Practice Location Address
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Address Line | 482 COUNTY ROAD 620
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City | POLK
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State | OH
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Zip | 44866-9711
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Country | US
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Telephone | 419-606-0006
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Fax |
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Provider Business Mailing Address
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Address Line | 482 COUNTY ROAD 620
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City | POLK
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State | OH
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Zip | 44866-9711
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Country | US
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Telephone | 419-606-0006
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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 | RN459694
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License Number State | OH
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