Provider Demographics
NPI:1407454929
Name:KOENIGSKNECHT, AYLA (FNP-C)
Entity Type:Individual
Prefix:
First Name:AYLA
Middle Name:
Last Name:KOENIGSKNECHT
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:AYLA
Other - Middle Name:GRACE
Other - Last Name:WASCZENSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:44344 DEQUINDRE RD STE 260
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48314-1040
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:44344 DEQUINDRE RD STE 260
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48314-1040
Practice Address - Country:US
Practice Address - Phone:248-894-9557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-16
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704318757363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily