Provider Demographics
NPI:1871522037
Name:KOEP, JULIA J (ARNP)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:J
Last Name:KOEP
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2514 N 7TH STREET
Mailing Address - Street 2:
Mailing Address - City:COEUR D'ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-3720
Mailing Address - Country:US
Mailing Address - Phone:208-827-1099
Mailing Address - Fax:
Practice Address - Street 1:N. 600 CECIL AVE
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854
Practice Address - Country:US
Practice Address - Phone:208-262-2800
Practice Address - Fax:208-262-2822
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA0159349363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8877507Medicare PIN
WAP 11452Medicare UPIN
WA8877507Medicare PIN