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Individual

DEBORAH KONKLE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
518 GREAT RD, ACTON, MA 01720-3415
(978) 263-4878
Mailing address
949 LIBERTY SQUARE RD, BOXBOROUGH, MA 01719-1139

Taxonomy

Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
368
MA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
771803
TUFTS MNT
MA
01
AA5412
HP MNT
MA
01
LD0069
BCBS MNT
MA
Enumeration date
12/01/2006
Last updated
07/08/2007
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