Provider Demographics
NPI:1710908942
Name:KOENIG, CYNTHIA J (NP)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:J
Last Name:KOENIG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 SHEYENNE ST
Mailing Address - Street 2:
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-2637
Mailing Address - Country:US
Mailing Address - Phone:701-234-4445
Mailing Address - Fax:701-234-4385
Practice Address - Street 1:1220 SHEYENNE ST
Practice Address - Street 2:
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078-2637
Practice Address - Country:US
Practice Address - Phone:701-234-4445
Practice Address - Fax:701-234-4385
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR24477363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
S02989Medicare UPIN