Individual
GENEVIEVE MARIE KONICKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4900 MUELLER BLVD, AUSTIN, TX 78723-3079
(855) 324-0091
Mailing address
4900 MUELLER BLVD, AUSTIN, TX 78723-3079
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA12417
TX
Other
Enumeration date
12/29/2018
Last updated
12/29/2018
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