Healthcare Provider Details

I. General information

NPI: 1316062771
Provider Name (Legal Business Name): ALYCE LORAYNE KONZ LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 BELLE AVE
MANKATO MN
56001-5250
US

IV. Provider business mailing address

605 HILLCREST AVE STE 130
OWATONNA MN
55060-3680
US

V. Phone/Fax

Practice location:
  • Phone: 507-344-8698
  • Fax: 507-344-8759
Mailing address:
  • Phone: 507-541-0290
  • Fax: 507-451-0291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberL011383-2
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: