Provider Demographics
NPI:1366541427
Name:KOEDEL, CHRISTIE LEIGH (CPNP)
Entity type:Individual
Prefix:MRS
First Name:CHRISTIE
Middle Name:LEIGH
Last Name:KOEDEL
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 CARROW ST
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-2604
Mailing Address - Country:US
Mailing Address - Phone:716-662-3443
Mailing Address - Fax:716-972-0374
Practice Address - Street 1:24 CARROW ST
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-2604
Practice Address - Country:US
Practice Address - Phone:716-662-3443
Practice Address - Fax:716-972-0374
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF381603363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY9512152OtherINDEPENDENT HEALTH ASSOCIATION
NY00026923001OtherUNIVERA HEALTHCARE
NY000560738003OtherBLUE CROSS/BLUE SHIELD (HEALTH NOW)
NY02529793Medicaid