Provider Demographics
NPI:1366653636
Name:KONCHAR, NIKI (IBCLC)
Entity Type:Individual
Prefix:MS
First Name:NIKI
Middle Name:
Last Name:KONCHAR
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 443
Mailing Address - Street 2:
Mailing Address - City:CHIRENO
Mailing Address - State:TX
Mailing Address - Zip Code:75937-0443
Mailing Address - Country:US
Mailing Address - Phone:936-558-8747
Mailing Address - Fax:936-362-2270
Practice Address - Street 1:249 COUNT ROADY 452
Practice Address - Street 2:
Practice Address - City:CHIRENO
Practice Address - State:TX
Practice Address - Zip Code:75937-0443
Practice Address - Country:US
Practice Address - Phone:936-558-8747
Practice Address - Fax:936-362-2270
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104-21259174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist