Provider Demographics
NPI:1861691701
Name:KOEHLINGER, DANIEL EVAN (RN, WCC)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:EVAN
Last Name:KOEHLINGER
Suffix:
Gender:M
Credentials:RN, WCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 COUNTY ROAD 302
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38833-9248
Mailing Address - Country:US
Mailing Address - Phone:662-427-9240
Mailing Address - Fax:
Practice Address - Street 1:246 COUNTY ROAD 302
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MS
Practice Address - Zip Code:38833-9248
Practice Address - Country:US
Practice Address - Phone:662-427-9240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR857592163WW0000X
MS2050710163WW0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0000XNursing Service ProvidersRegistered NurseWound Care