Provider Demographics
NPI:1356860100
Name:KONIECZNY, MARGARET C (APRN, CNP)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:C
Last Name:KONIECZNY
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 STRATFORD RD
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-2109
Mailing Address - Country:US
Mailing Address - Phone:708-253-5512
Mailing Address - Fax:
Practice Address - Street 1:1875 DEMPSTER ST STE 520
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1130
Practice Address - Country:US
Practice Address - Phone:847-720-6464
Practice Address - Fax:847-720-6463
Is Sole Proprietor?:No
Enumeration Date:2017-09-13
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.016392363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner