Provider Demographics
NPI:1326888975
Name:KOENIG, KIM MARGARET (RN)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:MARGARET
Last Name:KOENIG
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 STERLING WAY
Mailing Address - Street 2:
Mailing Address - City:OAKLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94561-4301
Mailing Address - Country:US
Mailing Address - Phone:408-806-6312
Mailing Address - Fax:
Practice Address - Street 1:234 STERLING WAY
Practice Address - Street 2:
Practice Address - City:OAKLEY
Practice Address - State:CA
Practice Address - Zip Code:94561-4301
Practice Address - Country:US
Practice Address - Phone:408-806-6312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1696193163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse