MEDICARE: DANA JOANN KOENNING NP

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	363LA2200X	Adult Health Nurse Practitioner	705499	TX

General Provider Information

NPI Number	:	1518208339
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANA JOANN KOENNING NP

Provider Business Mailing Address
First Line	:	2306 BUTLER DR
Second Line	:
City	:	FRIENDSWOOD
State	:	TX
Zip	:	77546-5518
Country	:	US
Telephone Number	:	281-684-6286
Fax Number	:	281-286-7557

Provider Business Practice Location Address
First Line	:	308 E EDGEWOOD DR
Second Line	:
City	:	FRIENDSWOOD
State	:	TX
Zip	:	77546-3823
Country	:	US
Telephone Number	:	281-684-6286
Fax Number	:

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

Provider Enumeration Date	:	03/04/2013
Last Update Date	:	08/19/2015

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