| NPI | 1780054015 |
|---|---|
| Former Name | STEPHEN WADE KOCH |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 7915) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner Adult Health (Licence: MN R137924) |
| 363LA2200X Nurse Practitioner Adult Health (Licence: WI 6663) | |
| Enumeration Date | 2015-09-29 |
| Last Update Date | 2020-12-01 |