Provider Demographics
NPI:1871564898
Name:KOENIG, DONNA L (FNP)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:L
Last Name:KOENIG
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5213 GODFREY RD.
Mailing Address - Street 2:#110
Mailing Address - City:GODFREY
Mailing Address - State:IL
Mailing Address - Zip Code:62035
Mailing Address - Country:US
Mailing Address - Phone:618-619-3330
Mailing Address - Fax:618-619-3385
Practice Address - Street 1:5213 GODFREY RD.
Practice Address - Street 2:#110
Practice Address - City:GODFREY
Practice Address - State:IL
Practice Address - Zip Code:62035
Practice Address - Country:US
Practice Address - Phone:618-619-3330
Practice Address - Fax:618-619-3385
Is Sole Proprietor?:No
Enumeration Date:2006-01-28
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209001008363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL208438Medicare ID - Type Unspecified
ILP56766Medicare UPIN