Provider Demographics
NPI:1356324834
Name:KONYA, MAURISA O (PA)
Entity Type:Individual
Prefix:
First Name:MAURISA
Middle Name:O
Last Name:KONYA
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:4550 E. BELL ROAD
Mailing Address - Street 2:SUITE 170
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032
Mailing Address - Country:US
Mailing Address - Phone:480-443-8400
Mailing Address - Fax:480-443-8697
Practice Address - Street 1:5601 W. EUGIE AVE.
Practice Address - Street 2:SUITE 204
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85304
Practice Address - Country:US
Practice Address - Phone:480-443-8400
Practice Address - Fax:480-443-8697
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2013-04-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ2531363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ2531OtherARIZONA PA LICENSE
AZQ33190Medicare UPIN