Healthcare Provider Details

I. General information

NPI: 1992940365
Provider Name (Legal Business Name): ANNE KONERU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2008
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 LIBERTY ST STE 2
SPRINGFIELD MA
01104-3766
US

IV. Provider business mailing address

701 COTTAGE GROVE RD STE B110
BLOOMFIELD CT
06002-4217
US

V. Phone/Fax

Practice location:
  • Phone: 413-301-9355
  • Fax:
Mailing address:
  • Phone: 203-637-5882
  • Fax: 855-524-3980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2259886
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number003957
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number3957
License Number StateCT
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2259886
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: