Mary Koenen, F.N.P.

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

MK4704154566 Issued in MI

Practice address

72 Sheldon Blvd SE
Grand Rapids, MI 49503-4234

Phone

(616) 988-8774

Fax

(616) 988-8775

NPI assigned

Jan 19, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Baxter Community Center

  • Public Health or Welfare Agency
  • Grand Rapids, MI
  • NPI 1164625109

  MI

  Medicare reassignment
• Grand Valley State University

  • Urgent Care Clinic/Center
  • Allendale, MI
  • NPI 1518019223

  Family

  NPD (past)
• Red Bird Clinic, Inc.

  • Dental Clinic/Center
  • Beverly, KY
  • NPI 1821084971
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1184777682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "72 SHELDON BLVD SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495034234",
            "telephone_number": "616-988-8774",
            "fax_number": "616-988-8775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "72 SHELDON BLVD SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495034234",
            "telephone_number": "616-988-8774",
            "fax_number": "616-988-8775"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOENEN",
        "first_name": "MARY",
        "credential": "F.N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "MK4704154566",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Peter Koehn, PH.D.
• Robert Koeller, DPT
• Jessica Koelling
• Molly Koelzer, MA, LLC
• Teresa M Koelzer, CRNA
• Samantha Koenen
• Sara Elizabeth Koepke, RD
• Grace Koerber, MA, BCBA
• Andrew Koerner
• Rachael Koeson, LLMSW

• All providers in Grand Rapids, MI
• Family Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.