Individual
MARY KOENEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
F.N.P.
Contact information
Practice address
72 SHELDON BLVD SE, GRAND RAPIDS, MI 49503-4234
(616) 988-8774
(616) 988-8775
Mailing address
72 SHELDON BLVD SE, GRAND RAPIDS, MI 49503-4234
(616) 988-8774
(616) 988-8775
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
MK4704154566
MI
Other
Enumeration date
01/19/2007
Last updated
07/08/2007
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