Provider Demographics
NPI:1144274002
Name:KONING, PATRICIA (GNP-C)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:KONING
Suffix:
Gender:F
Credentials:GNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12303 S WILLOW AVE
Mailing Address - Street 2:
Mailing Address - City:GRANT
Mailing Address - State:MI
Mailing Address - Zip Code:49327-9773
Mailing Address - Country:US
Mailing Address - Phone:231-349-1306
Mailing Address - Fax:
Practice Address - Street 1:1035 E WILCOX AVE
Practice Address - Street 2:
Practice Address - City:WHITE CLOUD
Practice Address - State:MI
Practice Address - Zip Code:49349-8794
Practice Address - Country:US
Practice Address - Phone:231-689-5943
Practice Address - Fax:231-689-1590
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704160886363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIM60190007Medicare ID - Type Unspecified
MIS95429Medicare UPIN
MI4337079Medicaid