Provider Demographics
NPI:1992005227
Name:KONICKI, RHONDA J (MSN, C-NP)
Entity Type:Individual
Prefix:MRS
First Name:RHONDA
Middle Name:J
Last Name:KONICKI
Suffix:
Gender:F
Credentials:MSN, C-NP
Other - Prefix:MRS
Other - First Name:RHONDA
Other - Middle Name:JANE
Other - Last Name:SALEHI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1235 E ALEX BELL RD
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459
Mailing Address - Country:US
Mailing Address - Phone:937-435-6400
Mailing Address - Fax:937-435-4793
Practice Address - Street 1:1235 E ALEX BELL RD
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459
Practice Address - Country:US
Practice Address - Phone:937-435-6400
Practice Address - Fax:937-435-4793
Is Sole Proprietor?:No
Enumeration Date:2010-11-03
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN 234035171W00000X
OH11986NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH11986NPOtherNP LICENSE
OH3011761Medicaid
OHE39983Medicare UPIN
OH11986NPOtherNP LICENSE