Healthcare Provider Details

I. General information

NPI: 1992005227
Provider Name (Legal Business Name): RHONDA J KONICKI MSN, C-NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. RHONDA JANE SALEHI

II. Dates (important events)

Enumeration Date: 11/03/2010
Last Update Date: 03/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1235 E ALEX BELL RD
CENTERVILLE OH
45459
US

IV. Provider business mailing address

1235 E ALEX BELL RD
CENTERVILLE OH
45459
US

V. Phone/Fax

Practice location:
  • Phone: 937-435-6400
  • Fax: 937-435-4793
Mailing address:
  • Phone: 937-435-6400
  • Fax: 937-435-4793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11986NP
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License NumberRN 234035
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: