Individual
MR. BRADLEY NEIL KOENIG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
1424 CHERRY ST, WAUSAU, WI 54401-2538
(715) 675-6267
Mailing address
1424 CHERRY ST, WAUSAU, WI 54401-2538
(715) 675-6267
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
157300
WI
163WH0200X
Home Health Registered Nurse
157300
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38324200
—
WI
Enumeration date
04/22/2008
Last updated
04/22/2008
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