Provider Demographics
NPI:1225824022
Name:KOEHLER, JORDAN ANN
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:ANN
Last Name:KOEHLER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 C ST # 707
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68502-1139
Mailing Address - Country:US
Mailing Address - Phone:402-414-7880
Mailing Address - Fax:
Practice Address - Street 1:724 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:NEBRASKA CITY
Practice Address - State:NE
Practice Address - Zip Code:68410-2451
Practice Address - Country:US
Practice Address - Phone:402-699-0540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-17
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEH13968894126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant