Individual
REBECCA KONKIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2700 LAFAYETTE ST, STE B-10, FORT WAYNE, IN 46806-1100
(260) 744-7004
Mailing address
2700 LAFAYETTE ST, STE B-10, FORT WAYNE, IN 46806-1100
(260) 744-7004
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71001535A
IN
Other
Enumeration date
04/20/2006
Last updated
10/30/2007
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