Provider Demographics
NPI:1790591121
Name:KONCZAL, MEGAN ASHLEY (RN)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:ASHLEY
Last Name:KONCZAL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11489 KILMANAGH RD
Mailing Address - Street 2:
Mailing Address - City:SEBEWAING
Mailing Address - State:MI
Mailing Address - Zip Code:48759-9768
Mailing Address - Country:US
Mailing Address - Phone:989-245-0173
Mailing Address - Fax:
Practice Address - Street 1:11489 KILMANAGH RD
Practice Address - Street 2:
Practice Address - City:SEBEWAING
Practice Address - State:MI
Practice Address - Zip Code:48759-9768
Practice Address - Country:US
Practice Address - Phone:989-245-0173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-10
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704315259163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse