Provider Demographics
NPI:1396247896
Name:KOEHLER, REBECCA
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:KOEHLER
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 1:14288 LADD RD
Mailing Address - Street 2:
Mailing Address - City:ATASCOSA
Mailing Address - State:TX
Mailing Address - Zip Code:78002-3584
Mailing Address - Country:US
Mailing Address - Phone:210-790-4348
Mailing Address - Fax:
Practice Address - Street 1:3201 CHERRY RIDGE ST STE D400
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-4820
Practice Address - Country:US
Practice Address - Phone:210-692-0222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-01
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX300789164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse