Provider Demographics
NPI:1659893170
Name:KOENIG, NAOMI (APRN,FNP-C, PMHNP-BC)
Entity Type:Individual
Prefix:DR
First Name:NAOMI
Middle Name:
Last Name:KOENIG
Suffix:
Gender:F
Credentials:APRN,FNP-C, PMHNP-BC
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 516
Mailing Address - Street 2:
Mailing Address - City:SANDSTONE
Mailing Address - State:MN
Mailing Address - Zip Code:55072-0516
Mailing Address - Country:US
Mailing Address - Phone:320-372-2323
Mailing Address - Fax:
Practice Address - Street 1:501 MAIN STREET
Practice Address - Street 2:
Practice Address - City:SANDSTONE
Practice Address - State:MN
Practice Address - Zip Code:55072
Practice Address - Country:US
Practice Address - Phone:320-372-2323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-17
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNF07170428363LF0000X
MN2023000773363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily