Provider Demographics
NPI:1881373025
Name:KOENIG, DANA JO (RN)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:JO
Last Name:KOENIG
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:JO
Other - Last Name:BOLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:801 BUCKEYE ST
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-4202
Mailing Address - Country:US
Mailing Address - Phone:970-744-9709
Mailing Address - Fax:
Practice Address - Street 1:801 BUCKEYE ST
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-4202
Practice Address - Country:US
Practice Address - Phone:970-744-9709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-14
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0081086163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse