Provider Demographics
NPI:1417149808
Name:KOEHLER, MEGAN JOYCE (RN)
Entity type:Individual
Prefix:MS
First Name:MEGAN
Middle Name:JOYCE
Last Name:KOEHLER
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:JOYCE
Other - Last Name:LUBACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:N3270 COUNTY ROAD T
Mailing Address - Street 2:
Mailing Address - City:NEW HOLSTEIN
Mailing Address - State:WI
Mailing Address - Zip Code:53061-9720
Mailing Address - Country:US
Mailing Address - Phone:920-698-0025
Mailing Address - Fax:
Practice Address - Street 1:N3270 COUNTY ROAD T
Practice Address - Street 2:
Practice Address - City:NEW HOLSTEIN
Practice Address - State:WI
Practice Address - Zip Code:53061-9720
Practice Address - Country:US
Practice Address - Phone:920-698-0025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-09
Last Update Date:2025-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI158262-030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI35032300Medicaid