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NPI Code Detail

MEDICARE: MS. CONSTANCE E. IKONOMOU FNP

MEDICARE: MS. CONSTANCE E. IKONOMOU FNP
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
1363LF0000XFamily Nurse PractitionerAP4691AZ

General Provider Information

NPI Number : 1841580610
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. CONSTANCE E. IKONOMOU FNP
Provider Business Mailing Address
First Line : 4254 W ORCHID LN
Second Line :
City : CHANDLER
State : AZ
Zip : 85226-7246
Country : US
Telephone Number : 888-731-8994
Fax Number :
Provider Business Practice Location Address
First Line : 4254 W ORCHID LN
Second Line :
City : CHANDLER
State : AZ
Zip : 85226-7246
Country : US
Telephone Number : 888-731-8994
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/14/2011
Last Update Date : 12/13/2024

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