Provider Demographics
NPI:1831861780
Name:KONSO, WINNIE (RN)
Entity type:Individual
Prefix:
First Name:WINNIE
Middle Name:
Last Name:KONSO
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 1:508 INDIAN LAKE SHORE DR
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:MA
Mailing Address - Zip Code:01749-3148
Mailing Address - Country:US
Mailing Address - Phone:617-913-7182
Mailing Address - Fax:
Practice Address - Street 1:508 INDIAN LAKE SHORE DR
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:MA
Practice Address - Zip Code:01749-3148
Practice Address - Country:US
Practice Address - Phone:617-913-7182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-29
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2310580163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health