Provider Demographics
NPI:1164660353
Name:KOENIG, CARMEN MARTELL (NP)
Entity Type:Individual
Prefix:MS
First Name:CARMEN
Middle Name:MARTELL
Last Name:KOENIG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CARMEN
Other - Middle Name:MARTELL
Other - Last Name:ZUNIGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1275 E SPRUCE AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3372
Mailing Address - Country:US
Mailing Address - Phone:559-432-0716
Mailing Address - Fax:559-261-4500
Practice Address - Street 1:1275 E SPRUCE AVE STE 103
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3372
Practice Address - Country:US
Practice Address - Phone:559-432-0716
Practice Address - Fax:559-432-4545
Is Sole Proprietor?:No
Enumeration Date:2009-01-27
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP17317363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner