Provider Demographics
NPI:1750938635
Name:KOERNER, CHRISTIAN RANDOLPH (CNS-AG)
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:RANDOLPH
Last Name:KOERNER
Suffix:
Gender:M
Credentials:CNS-AG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7940 SUMTER RIDGE LN APT 5110
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27617-6734
Mailing Address - Country:US
Mailing Address - Phone:919-400-5011
Mailing Address - Fax:919-400-5809
Practice Address - Street 1:7940 SUMTER RIDGE LN APT 5110
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27617-6734
Practice Address - Country:US
Practice Address - Phone:910-805-0306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-24
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC303322163W00000X
NC547364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
No163W00000XNursing Service ProvidersRegistered Nurse