# STACEY LEE KONZAK

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1962486969
- **Gender:** F
- **Credential:** PA C

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | 0537 | SD | — |
| 363A00000X | Physician Assistant | PAC0348 | ND | Yes |

## Other

- **Enumeration date:** 12/02/2005
- **Last updated:** 09/18/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 6825030 | — | SD |
| 05 | — | 71237 | — | ND |