Individual
ANDREI IVANOVICH KONONOVICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
1100 MARSHALL WAY, PLACERVILLE, CA 95667-6533
(530) 622-1441
Mailing address
2301 FICUS CIR, EL DORADO HLS, CA 95762-6812
Taxonomy
Speciality
Code
Description
License number
State
163WM0705X
Medical-Surgical Registered Nurse
Primary
95186212
CA
Other
Enumeration date
04/14/2020
Last updated
04/14/2020
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