Provider Demographics
NPI:1891231866
Name:KOELLER, KAREN MARIE (NP-C)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:MARIE
Last Name:KOELLER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ONE HOAG DRIVE, BLDG 41, 3RD FLOOR
Mailing Address - Street 2:HOAG MEDICAL ONCOLOGY CLINIC
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-4162
Mailing Address - Country:US
Mailing Address - Phone:949-764-6130
Mailing Address - Fax:
Practice Address - Street 1:ONE HOAG DRIVE, BLDG 41, 3RD FLOOR
Practice Address - Street 2:HOAG MEDICAL ONCOLOGY CLINIC
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-4162
Practice Address - Country:US
Practice Address - Phone:949-764-6130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-13
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95004521363LA2200X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily