MEDICARE: LISA KONIECZYNSKI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1114316932
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LISA KONIECZYNSKI

Provider Business Mailing Address
First Line	:	795 LOCH LOMOND LN
Second Line	:
City	:	WORTHINGTON
State	:	OH
Zip	:	43085-2933
Country	:	US
Telephone Number	:	614-634-8464
Fax Number	:

Provider Business Practice Location Address
First Line	:	795 LOCH LOMOND LN
Second Line	:
City	:	WORTHINGTON
State	:	OH
Zip	:	43085-2933
Country	:	US
Telephone Number	:	614-634-8464
Fax Number	:

Authorized Official
Title or Position	:	INDEPENDENT CONTRACTOR
Name	:	LISA KONIECZYNSKI
Credential	:
Telephone Number	:	614-634-8464

Provider Enumeration Date	:	01/16/2015
Last Update Date	:	01/16/2015

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