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General NPI Number Information
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NPI Number | 1841580610
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Entity Type | Individual
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Provider Name | CONSTANCE E. IKONOMOU FNP
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Gender | Female
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Dates
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Enumeration Date | 04/14/2011
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Last Update Date | 12/13/2024
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Provider Practice Location Address
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Address Line | 4254 W ORCHID LN
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City | CHANDLER
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State | AZ
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Zip | 85226-7246
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Country | US
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Telephone | 888-731-8994
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Fax |
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Provider Business Mailing Address
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Address Line | 4254 W ORCHID LN
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City | CHANDLER
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State | AZ
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Zip | 85226-7246
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Country | US
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Telephone | 888-731-8994
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP4691
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License Number State | AZ
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