Basic Information
| Provider Information | |||||||||
| NPI: | 1134125594 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KOEPPING | ||||||||
| FirstName: | MARGARET | ||||||||
| MiddleName: | JULIE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RN-BC, MN, F.N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 357 | ||||||||
| Address2: | |||||||||
| City: | WELLPINIT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 990400357 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5092584517 | ||||||||
| FaxNumber: | 5092586757 | ||||||||
| Practice Location | |||||||||
| Address1: | 6203 AGENCY LOOP ROAD | ||||||||
| Address2: | |||||||||
| City: | WELLPINIT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 990400357 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5092584517 | ||||||||
| FaxNumber: | 5092586757 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2005 | ||||||||
| LastUpdateDate: | 12/29/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN00089058 | WA | N | Nursing Service Providers | Registered Nurse | 363LF0000X | AP30004280 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | 200150019NP FNP PP | OR | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 2003298 | 05 | WA | MEDICAID |