MEDICARE: DIAN FORRESTER KOELZER FNP

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
1	363LF0000X	Family Nurse Practitioner	499424	CA

General Provider Information

NPI Number	:	1609979772
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIAN FORRESTER KOELZER FNP

Provider Business Mailing Address
First Line	:	2155 IRON POINT RD
Second Line	:
City	:	FOLSOM
State	:	CA
Zip	:	95630-8707
Country	:	US
Telephone Number	:	916-817-5659
Fax Number	:

Provider Business Practice Location Address
First Line	:	2155 IRON POINT RD
Second Line	:
City	:	FOLSOM
State	:	CA
Zip	:	95630-8707
Country	:	US
Telephone Number	:	916-817-5659
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	07/11/2007

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