Individual
BRANDI KONIECZYNSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
104 W D. L. INGRAM AVE, CANNON AFB, NM 88101
(575) 904-3802
Mailing address
104 W D. L. INGRAM AVE, CANNON AFB, NM 88101
Taxonomy
Speciality
Code
Description
License number
State
1710I1003X
Independent Duty Medical Technicians
Primary
—
—
Other
Enumeration date
10/23/2019
Last updated
07/16/2024
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