Provider Demographics
NPI:1992793525
Name:KONING, CORALEE RUTH (PA-C)
Entity type:Individual
Prefix:MRS
First Name:CORALEE
Middle Name:RUTH
Last Name:KONING
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:CORALEE
Other - Middle Name:RUTH
Other - Last Name:LOBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2625 E DIVISADERO ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93721-1431
Mailing Address - Country:US
Mailing Address - Phone:559-443-2682
Mailing Address - Fax:559-443-2681
Practice Address - Street 1:2335 E KASHIAN LN STE 260
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93701-2234
Practice Address - Country:US
Practice Address - Phone:559-256-5130
Practice Address - Fax:559-485-4504
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60188369363A00000X
ORPA153205363A00000X
CAPA14217363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500655889Medicaid
WAP01238392OtherRAILROAD MEDICARE - PHS - WA
ORR172389Medicare PIN
WAG8918888Medicare PIN
ORR169885Medicare PIN
ORR172898Medicare PIN
ORR169889Medicare PIN
WAP01238392OtherRAILROAD MEDICARE - PHS - WA
OR500655889Medicaid
ORR169884Medicare PIN
ORR169887Medicare PIN
ORR169888Medicare PIN
CADE6012Medicare PIN