Healthcare Provider Details

I. General information

NPI: 1598529539
Provider Name (Legal Business Name): CHRISTINE NORA KOENIG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2024
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2430 EMERALD PL STE 201
GREENVILLE NC
27834-5743
US

IV. Provider business mailing address

2430 EMERALD PL STE 201
GREENVILLE NC
27834-5743
US

V. Phone/Fax

Practice location:
  • Phone: 252-561-8218
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number322204
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number5020733
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: