Provider Demographics
NPI:1912257890
Name:KOERNER, MICHELE (NP)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:KOERNER
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 1:1316 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CLARION
Mailing Address - State:IA
Mailing Address - Zip Code:50525-2019
Mailing Address - Country:US
Mailing Address - Phone:515-532-2811
Mailing Address - Fax:515-532-3443
Practice Address - Street 1:215 13TH AVE SW
Practice Address - Street 2:
Practice Address - City:CLARION
Practice Address - State:IA
Practice Address - Zip Code:50525-2078
Practice Address - Country:US
Practice Address - Phone:515-532-2836
Practice Address - Fax:515-532-2523
Is Sole Proprietor?:No
Enumeration Date:2012-09-18
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA077923363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily