Provider Demographics
NPI:1982851556
Name:KOACHWAY, SHIRLEY HILLEN (RN)
Entity type:Individual
Prefix:MS
First Name:SHIRLEY
Middle Name:HILLEN
Last Name:KOACHWAY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3416 COLUMBUS AVE
Mailing Address - Street 2:SANDUSKY CBOC
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-5557
Mailing Address - Country:US
Mailing Address - Phone:419-625-7350
Mailing Address - Fax:419-625-6660
Practice Address - Street 1:3416 COLUMBUS AVE
Practice Address - Street 2:SANDUSKY CBOC
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-5557
Practice Address - Country:US
Practice Address - Phone:419-625-7350
Practice Address - Fax:419-625-6660
Is Sole Proprietor?:No
Enumeration Date:2008-08-26
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN171031163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care