Individual
STACEY LEE KONZAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA C
Contact information
Practice address
2900 E BROADWAY AVE, BISMARCK, ND 58501-5112
(701) 221-9997
Mailing address
5713 80TH AVE NE, DEVILS LAKE, ND 58301-9657
(701) 303-0263
(701) 395-4456
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0537
SD
363A00000X
Physician Assistant
Primary
PAC0348
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6825030
—
SD
05
—
71237
—
ND
Enumeration date
12/02/2005
Last updated
09/18/2014
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