Healthcare Provider Details

I. General information

NPI: 1811299266
Provider Name (Legal Business Name): SHANNA LYNN KONZ CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHANNA LYNN STEIN

II. Dates (important events)

Enumeration Date: 11/17/2010
Last Update Date: 09/07/2025
Certification Date: 09/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 8TH ST S
BROOKINGS SD
57006-4907
US

IV. Provider business mailing address

421 8TH ST S
BROOKINGS SD
57006-4907
US

V. Phone/Fax

Practice location:
  • Phone: 605-782-2273
  • Fax:
Mailing address:
  • Phone: 605-521-5116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCP000626
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: