Provider Demographics
NPI:1356123392
Name:KOENIG, MIKAYLA (RDN, LRD)
Entity type:Individual
Prefix:
First Name:MIKAYLA
Middle Name:
Last Name:KOENIG
Suffix:
Gender:F
Credentials:RDN, LRD
Other - Prefix:
Other - First Name:MIKAYLA
Other - Middle Name:
Other - Last Name:HANKEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:719 2ND AVE W UNIT 2
Mailing Address - Street 2:
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-1546
Mailing Address - Country:US
Mailing Address - Phone:701-840-7798
Mailing Address - Fax:
Practice Address - Street 1:1112 NODAK DR S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-2333
Practice Address - Country:US
Practice Address - Phone:701-232-6224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1493133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered