Healthcare Provider Details

I. General information

NPI: 1164471165
Provider Name (Legal Business Name): JOYCE ANNE LAWRENCE-KOENIG PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 07/23/2024
Certification Date: 07/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MEDICAL PKWY FL 2
CHESAPEAKE VA
23320-0302
US

IV. Provider business mailing address

PO BOX 11314
BELFAST ME
04915-4004
US

V. Phone/Fax

Practice location:
  • Phone: 757-312-5166
  • Fax: 757-312-6184
Mailing address:
  • Phone: 757-842-4481
  • Fax: 757-312-3135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110002127
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: