Provider Demographics
NPI:1659468825
Name:KONESNI, EDITH (PA)
Entity Type:Individual
Prefix:MRS
First Name:EDITH
Middle Name:
Last Name:KONESNI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 FAHEY ST
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-6028
Mailing Address - Country:US
Mailing Address - Phone:207-338-1120
Mailing Address - Fax:207-338-9784
Practice Address - Street 1:150 MAIN ROAD
Practice Address - Street 2:
Practice Address - City:ISLESBORO
Practice Address - State:ME
Practice Address - Zip Code:04848-0137
Practice Address - Country:US
Practice Address - Phone:207-734-2213
Practice Address - Fax:207-734-8392
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA-191363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME288030099Medicaid