Provider Demographics
NPI:1295413417
Name:KOENA LLC
Entity type:Organization
Organization Name:KOENA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYNDSEY
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:CORDOVA
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:720-487-8333
Mailing Address - Street 1:713 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-5926
Mailing Address - Country:US
Mailing Address - Phone:303-834-8376
Mailing Address - Fax:
Practice Address - Street 1:620 KIMBARK ST
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-4911
Practice Address - Country:US
Practice Address - Phone:303-834-8376
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-07
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty