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General NPI Number Information
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NPI Number | 1992084297
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Entity Type | Individual
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Provider Name | HEATHER LYNN KONIARCZYK NP-C
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Gender | Female
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Dates
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Enumeration Date | 08/04/2011
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Last Update Date | 03/23/2017
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Provider Practice Location Address
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Address Line | 10201 CARNEGIE AVE CA6-61
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City | CLEVELAND
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State | OH
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Zip | 44106-2130
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Country | US
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Telephone | 216-618-2230
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Fax |
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Provider Business Mailing Address
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Address Line | 6890 BRIDGECREEK DR
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City | CONCORD TWP
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State | OH
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Zip | 44077-2355
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Country | US
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Telephone | 440-655-5911
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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 | COA.12507
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License Number State | OH
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