Provider Demographics
NPI:1811141112
Name:KONKOLY, ANN MARIE AULETTA (CNM)
Entity type:Individual
Prefix:MRS
First Name:ANN MARIE
Middle Name:AULETTA
Last Name:KONKOLY
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:MISS
Other - First Name:ANN MARIE
Other - Middle Name:
Other - Last Name:AULETTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:24300 CHAGRIN BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5629
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:24300 CHAGRIN BLVD STE 103
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5629
Practice Address - Country:US
Practice Address - Phone:216-245-3254
Practice Address - Fax:440-596-4711
Is Sole Proprietor?:No
Enumeration Date:2008-11-13
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.10116-NM367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2968436Medicaid
OH585444OtherWELLCARE MEDICAID
OH585444OtherWELLCARE MEDICAID