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NPI Code Detail

MEDICARE: DANIELLE EMILY KOCH NP

MEDICARE: DANIELLE EMILY KOCH NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner4704237870MI

General Provider Information

NPI Number : 1275771370
Entity Type Code : Individual
Provider Name (Legal Business Name) : DANIELLE EMILY KOCH NP
Provider Business Mailing Address
First Line : 6227 FRANKFORT HWY
Second Line :
City : BENZONIA
State : MI
Zip : 49616-8632
Country : US
Telephone Number : 231-882-9661
Fax Number : 231-882-9616
Provider Business Practice Location Address
First Line : 5191 ROSEWOOD DR
Second Line :
City : TRAVERSE CITY
State : MI
Zip : 49685-9137
Country : US
Telephone Number : 231-922-0667
Fax Number : 231-922-0668
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/27/2009
Last Update Date : 07/14/2020

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