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General NPI Number Information
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NPI Number | 1295413417
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Entity Type | Organization
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Legal Business Name | KOENA LLC
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Dates
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Enumeration Date | 07/07/2023
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Last Update Date | 03/07/2025
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Provider Practice Location Address
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Address Line | 620 KIMBARK ST
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City | LONGMONT
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State | CO
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Zip | 80501-4911
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Country | US
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Telephone | 303-834-8376
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Fax |
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Provider Business Mailing Address
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Address Line | 713 3RD AVE
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City | LONGMONT
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State | CO
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Zip | 80501-5926
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Country | US
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Telephone | 303-834-8376
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | LYNDSEY RENEE CORDOVA
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Credential | LAC
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Telephone | 720-487-8333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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