Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 26894 | NE |
NPI | 1003107418 |
---|---|
Provider Name | Dr. Debra A Koenigsberger |
First Address | Nellis Afb, NV 89191-6600 |
Second Address | Nellis Afb, NV 89191-6600 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2011 |
Last Update Date | 04/06/2015 |