Provider Demographics
NPI:1487195871
Name:KONOPKA, BRETTE (APN)
Entity Type:Individual
Prefix:
First Name:BRETTE
Middle Name:
Last Name:KONOPKA
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2271 HIGHWAY 33
Mailing Address - Street 2:STE 103
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08690-1749
Mailing Address - Country:US
Mailing Address - Phone:609-890-4080
Mailing Address - Fax:609-890-4090
Practice Address - Street 1:1001 LAUREL OAK RD
Practice Address - Street 2:SUITE A-2
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-3512
Practice Address - Country:US
Practice Address - Phone:856-888-4115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-17
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00716900363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner