MEDICARE: DONNA L KOENIG FNP

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	363L00000X	Nurse Practitioner	209001008	IL

General Provider Information

NPI Number	:	1871564898
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONNA L KOENIG FNP

Provider Business Mailing Address
First Line	:	5213 GODFREY RD.
Second Line	:	#110
City	:	GODFREY
State	:	IL
Zip	:	62035
Country	:	US
Telephone Number	:	618-619-3330
Fax Number	:	618-619-3385

Provider Business Practice Location Address
First Line	:	5213 GODFREY RD.
Second Line	:	#110
City	:	GODFREY
State	:	IL
Zip	:	62035
Country	:	US
Telephone Number	:	618-619-3330
Fax Number	:	618-619-3385

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

Provider Enumeration Date	:	01/28/2006
Last Update Date	:	02/06/2024

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