Provider Demographics
NPI:1740748649
Name:KONING, BRENDAN PAUL (APRN, CPNP)
Entity type:Individual
Prefix:
First Name:BRENDAN
Middle Name:PAUL
Last Name:KONING
Suffix:
Gender:M
Credentials:APRN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11717 OLD NATIONAL PIKE STE 8
Mailing Address - Street 2:
Mailing Address - City:NEW MARKET
Mailing Address - State:MD
Mailing Address - Zip Code:21774-6119
Mailing Address - Country:US
Mailing Address - Phone:301-882-7489
Mailing Address - Fax:
Practice Address - Street 1:11717 OLD NATIONAL PIKE STE 8
Practice Address - Street 2:
Practice Address - City:NEW MARKET
Practice Address - State:MD
Practice Address - Zip Code:21774-6119
Practice Address - Country:US
Practice Address - Phone:301-882-7489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-10
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11006116363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics