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MARY C KOOGLER FNP ONC
>> Nurse Practitioner >> Physician Assistants & Advanced Practice Nursing ProvidersRegistrant NPI Number: 1912908468
Individual Registrant: MARY C KOOGLER FNP ONC
Gender: F
Not Sole Proprietor
Gender: F
Not Sole Proprietor
Location and contact information for practice:
100 7TH STREET GROTTOES, VA 24441-0489 US
Tel: 540-249-5901 Fax: 540-249-5902
Tel: 540-249-5901 Fax: 540-249-5902
Contact information for business:
100 SEVENTH ST GROTTOES, VA 24441 US
Tel: 540-249-5901 Fax: 540-249-5902
Tel: 540-249-5901 Fax: 540-249-5902
Registration Information:
NPI: 1912908468
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner | VA | 0024-120331 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| 007795050 | VA | 05 | |
| ANTHEM | 270565 | 01 |
