Provider Demographics
NPI:1730874611
Name:KOEHN, ELI
Entity type:Individual
Prefix:
First Name:ELI
Middle Name:
Last Name:KOEHN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 171
Mailing Address - Street 2:
Mailing Address - City:AMESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45711-0171
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13499 HOWARD RD
Practice Address - Street 2:
Practice Address - City:MILLFIELD
Practice Address - State:OH
Practice Address - Zip Code:45761-9763
Practice Address - Country:US
Practice Address - Phone:740-517-6098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-06
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker