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General NPI Number Information
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NPI Number | 1124449434
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Entity Type | Individual
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Provider Name | MS. ELENA KONAKOVA
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Gender | Female
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Dates
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Enumeration Date | 01/05/2014
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Last Update Date | 03/03/2017
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Provider Practice Location Address
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Address Line | 10101 ACADEMY RD SUITE 104
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City | PHILADELPHIA
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State | PA
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Zip | 19114-1177
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Country | US
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Telephone | 215-710-3783
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Fax |
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Provider Business Mailing Address
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Address Line | 857 THOREAU CT
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City | WARMINSTER
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State | PA
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Zip | 18974-2057
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | SP012935
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | SP017116
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License Number State | PA
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