Healthcare Provider Details

I. General information

NPI: 1437488160
Provider Name (Legal Business Name): CATHERINE LOUISE KONYN ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2009
Last Update Date: 12/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 E GRAND AVE
ESCONDIDO CA
92025-4604
US

IV. Provider business mailing address

2185 CITRACADO PKWY
ESCONDIDO CA
92029-4159
US

V. Phone/Fax

Practice location:
  • Phone: 760-520-8200
  • Fax: 760-737-5490
Mailing address:
  • Phone: 442-281-4047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number255478
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number19095
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number1321
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code364SC1501X
TaxonomyCommunity Health/Public Health Clinical Nurse Specialist
License Number30210
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: