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Individual

MRS. LORA LEA KOENIG

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
1035 ROSE LN, RIVERTON, WY 82501-2291
(307) 233-6000
(307) 233-6089
Mailing address
5000 BLACKMORE RD, CASPER, WY 82609-3345
(307) 233-6000
(307) 233-6089

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
20484
WY
363LF0000X
Family Nurse Practitioner
1792
WY
363LF0000X
Family Nurse Practitioner
Primary
20484.1792
WY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1912419623
WY
Enumeration date
11/03/2017
Last updated
01/08/2021
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