Individual
MELLISA YU KOENINGS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1155 N MAYFAIR RD, WAUWATOSA, WI 53226-3462
(414) 955-5990
(414) 955-6282
Mailing address
1155 N MAYFAIR RD, WAUWATOSA, WI 53226-3462
(414) 955-5990
(414) 955-6282
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
3842-23
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1912350208
—
WI
Enumeration date
07/21/2016
Last updated
01/04/2024
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