Individual
MARIAH KOENEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
700 WEST AVE S, LA CROSSE, WI 54601-4783
(608) 785-0940
Mailing address
200 1ST ST SW, ROCHESTER, MN 55905-5429
(608) 785-0940
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
11699
MN
363A00000X
Physician Assistant
Primary
3480
WI
Other
Enumeration date
09/10/2014
Last updated
07/15/2021
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