Individual
KELLY KONESKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
8400 WASHINGTON AVE, MOUNT PLEASANT, WI 53406-3735
(262) 884-8340
Mailing address
PO BOX 735031, CHICAGO, IL 60673-5031
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
1512
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
43913500
—
WI
01
—
P00989255
RR MEDICARE
WI
Enumeration date
11/02/2005
Last updated
02/01/2024
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