1639246093 NPI number — MS. ROXANNE KOENIG MS, LIMHP #442

Table of content: MS. ROXANNE KOENIG MS, LIMHP #442 (NPI 1639246093)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639246093 NPI number — MS. ROXANNE KOENIG MS, LIMHP #442

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOENIG
Provider First Name:
ROXANNE
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MS, LIMHP #442
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KOENIG
Provider Other First Name:
ROXANNE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS, LMHP #557
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1639246093
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/18/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
919 GALVIN ROAD
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
BELLEVUE
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68005-2207
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-658-0103
Provider Business Mailing Address Fax Number:
402-296-5556

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
919 GALVIN ROAD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68005-2207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-658-0103
Provider Business Practice Location Address Fax Number:
402-591-5075
Provider Enumeration Date:
11/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  557 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com