Basic Information
| Provider Information | |||||||||
| NPI: | 1275049298 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOENEN | ||||||||
| FirstName: | JANELLE | ||||||||
| MiddleName: | ROWAN | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 202 S PARK ST | ||||||||
| Address2: | |||||||||
| City: | MADISON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 537151507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6084173886 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2996 7TH AVE | ||||||||
| Address2: | |||||||||
| City: | MARION | ||||||||
| State: | IA | ||||||||
| PostalCode: | 523023713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3193774844 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/28/2017 | ||||||||
| LastUpdateDate: | 12/12/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/12/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.