ELLISE SUZANNE KOENN

FORT WAYNE, IN
NPI1952897092
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy363LF0000X Nurse Practitioner, Family
(Licence: IN  71012516A)
Additional Taxonomies207Q00000X Family Medicine
(Licence: OH  APRN.CNP.023023)
Enumeration Date2018-07-02
Last Update Date2023-02-01
Business Address
ELLISE SUZANNE KOENN NP
10228 DUPONT CIRCLE DR E STE 100
FORT WAYNE, IN 46825-1611
Phone number: 260-222-7401
Mailing Address
ELLISE SUZANNE KOENN NP
PO BOX 772437
DETROIT, MI 48277-2437
Phone number: 317-575-7304