Provider Demographics
NPI:1023880481
Name:KOESTER, RUTH PETZOLD (PHD, F(ACHI))
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:PETZOLD
Last Name:KOESTER
Suffix:
Gender:F
Credentials:PHD, F(ACHI)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 YORK CT
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-3361
Mailing Address - Country:US
Mailing Address - Phone:336-436-7310
Mailing Address - Fax:
Practice Address - Street 1:1440 YORK CT
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-3361
Practice Address - Country:US
Practice Address - Phone:336-436-7310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-27
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physician