Provider Demographics
NPI:1386276384
Name:KOEHN, DEBORAH LYNN
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:LYNN
Last Name:KOEHN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 163
Mailing Address - Street 2:
Mailing Address - City:WOODY CREEK
Mailing Address - State:CO
Mailing Address - Zip Code:81656-0163
Mailing Address - Country:US
Mailing Address - Phone:970-309-3835
Mailing Address - Fax:
Practice Address - Street 1:41 HOOKENA BEACH ROAD
Practice Address - Street 2:
Practice Address - City:HONAUNAU
Practice Address - State:HI
Practice Address - Zip Code:96726
Practice Address - Country:US
Practice Address - Phone:970-309-3835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-07
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR42326055174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist