Healthcare Provider Details

I. General information

NPI: 1902110117
Provider Name (Legal Business Name): DEBRA KOENIGS-GAPP PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2010
Last Update Date: 07/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 W SUPERSTITION BLVD STE 101
APACHE JUNCTION AZ
85120-4127
US

IV. Provider business mailing address

212 W SUPERSTITION BLVD STE 101
APACHE JUNCTION AZ
85120-4127
US

V. Phone/Fax

Practice location:
  • Phone: 480-398-1220
  • Fax: 480-983-4317
Mailing address:
  • Phone: 480-398-1228
  • Fax: 480-398-1238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number4652
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: