Provider Demographics
NPI:1558489393
Name:KONOPELSKI, JOHN VINCENT (APN)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:VINCENT
Last Name:KONOPELSKI
Suffix:
Gender:M
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 W KENDALL DR
Mailing Address - Street 2:
Mailing Address - City:YORKVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60560-1039
Mailing Address - Country:US
Mailing Address - Phone:630-553-1030
Mailing Address - Fax:
Practice Address - Street 1:76 S LASALLE ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60505-3375
Practice Address - Country:US
Practice Address - Phone:630-264-0916
Practice Address - Fax:630-264-1607
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209004282363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209004282OtherADVANCED PRACTICE NURSING