Provider Demographics
NPI:1841340726
Name:KOENIG, RACHEL MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:MARIE
Last Name:KOENIG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:MARIE
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 1ST ST SW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55905-0001
Mailing Address - Country:US
Mailing Address - Phone:651-267-5000
Mailing Address - Fax:
Practice Address - Street 1:701 HEWITT BLVD
Practice Address - Street 2:
Practice Address - City:RED WING
Practice Address - State:MN
Practice Address - Zip Code:55066-2848
Practice Address - Country:US
Practice Address - Phone:651-267-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4328-23363A00000X
MN1678363A00000X
WAPA10005119363A00000X
MN11068363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
0217012OtherLABOR & INDUSTRIES
6168PEOtherREGENCE
P00391319OtherRAILROAD MEDICARE
6168PEOtherREGENCE
G8864085Medicare PIN
P00391319OtherRAILROAD MEDICARE
MN970005983Medicare PIN
G8864084Medicare PIN