Provider Demographics
NPI:1164471165
Name:LAWRENCE-KOENIG, JOYCE ANNE (PA)
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:ANNE
Last Name:LAWRENCE-KOENIG
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11314
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4004
Mailing Address - Country:US
Mailing Address - Phone:757-842-4481
Mailing Address - Fax:757-312-3135
Practice Address - Street 1:648 GRASSFIELD PKWY STE 1
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-7465
Practice Address - Country:US
Practice Address - Phone:757-312-4047
Practice Address - Fax:757-410-0339
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110002127363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010212979Medicaid
VA017391R53Medicare PIN
VA010212979Medicaid