Provider Demographics
NPI:1003955774
Name:KOERNER, FAYE L (CRNP)
Entity Type:Individual
Prefix:
First Name:FAYE
Middle Name:L
Last Name:KOERNER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:FAYE
Other - Middle Name:F
Other - Last Name:KOERNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:247 E. MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157
Mailing Address - Country:US
Mailing Address - Phone:443-289-8149
Mailing Address - Fax:443-821-3280
Practice Address - Street 1:247 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-5228
Practice Address - Country:US
Practice Address - Phone:443-289-8149
Practice Address - Fax:443-821-3280
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR038325363LA2200X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health