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Individual

MARIA C KONEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CRNA

Contact information

Practice address
700 S MAIN ST, MOSCOW, ID 83843-3056
(208) 883-6350
Mailing address
700 S MAIN ST, MOSCOW, ID 83843-3056
(208) 883-6350

Taxonomy

Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
N28761
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
14-93064-111
KANSAS LICENSE
KS
05
807575400
ID
05
9650516
WA
01
A4598
BC ID
ID
01
N28761
IDAHO LICENSE
ID
01
P00357946
RR MEDICARE
ID
01
P00357946
RAILROAD MEDICARE
Enumeration date
07/29/2006
Last updated
10/22/2019
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