Basic Information
| Provider Information | |||||||||
| NPI: | 1659558062 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KOEPP | ||||||||
| FirstName: | JOANN | ||||||||
| MiddleName: | CELESTE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | R.N. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 68625 PEREZ RD STE 11A | ||||||||
| Address2: | |||||||||
| City: | CATHEDRAL CTY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922347250 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7607736767 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 68-625 PEREZ ROAD SUITE 11A | ||||||||
| Address2: | |||||||||
| City: | CATHEDRAL CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92234 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7607736760 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/28/2008 | ||||||||
| LastUpdateDate: | 01/11/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0808X | 586538 | CA | Y | Nursing Service Providers | Registered Nurse | Psych/Mental Health |
No ID Information.