MEDICARE: MRS. DOROTHY A KOENIG APNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	1372-033	WI

General Provider Information

NPI Number	:	1124241823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DOROTHY A KOENIG APNP

Provider Business Mailing Address
First Line	:	S67W14976 KOSO DR
Second Line	:
City	:	MUSKEGO
State	:	WI
Zip	:	53150-8322
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8885 S 68TH ST
Second Line	:
City	:	FRANKLIN
State	:	WI
Zip	:	53132-8202
Country	:	US
Telephone Number	:	414-427-4706
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	07/08/2007

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