Provider Demographics
NPI:1326203340
Name:KONEN, PHILOMENA MARY (APRN BC)
Entity Type:Individual
Prefix:MRS
First Name:PHILOMENA
Middle Name:MARY
Last Name:KONEN
Suffix:
Gender:F
Credentials:APRN BC
Other - Prefix:
Other - First Name:PHYLLIS
Other - Middle Name:MARY
Other - Last Name:KONEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN BC
Mailing Address - Street 1:19 N GREEN ACRE DR
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-1003
Mailing Address - Country:US
Mailing Address - Phone:267-425-4666
Mailing Address - Fax:
Practice Address - Street 1:34TH STREET & CIVIC CENTER BOULEVARD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4399
Practice Address - Country:US
Practice Address - Phone:267-425-4666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-21
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP007605363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily