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Individual

DEBRA R KOENIG

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CRNA

Contact information

Practice address
1 MEDICAL VILLAGE DR, EDGEWOOD, KY 41017-3403
(859) 341-7246
(859) 341-7867
Mailing address
20 MEDICAL VILLAGE DR, STE 258, EDGEWOOD, KY 41017-5401
(859) 341-7246
(859) 341-7867

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
1053847
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000288570
ANTHEM BLUE SHIELD
05
0875183
OH
05
200418550
IN
05
74408725
KY
Enumeration date
12/08/2005
Last updated
12/16/2010
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