MEDICARE: PATRICIA KONZMAN CNM

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	176B00000X	Midwife	MW008321L	PA

General Provider Information

NPI Number	:	1396837175
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA KONZMAN CNM

Provider Business Mailing Address
First Line	:	110 PARK ST
Second Line	:
City	:	HONESDALE
State	:	PA
Zip	:	18431-2023
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	626 PARK ST
Second Line	:
City	:	HONESDALE
State	:	PA
Zip	:	18431-1446
Country	:	US
Telephone Number	:	570-253-3005
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2006
Last Update Date	:	05/28/2024

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