Individual
MS. HEATHER KONZELMANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1801 WINDSOR RD, CHAMPAIGN, IL 61822-6217
(217) 366-8130
Mailing address
101 W UNIVERSITY AVE, CHAMPAIGN, IL 61820-3909
(217) 366-8107
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9103440
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
Q54584
RAILROAD MEDICARE
FL
Enumeration date
01/05/2006
Last updated
12/05/2014
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