Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 18062 | OR |
NPI | 1003188418 |
---|---|
Provider Name | Mrs. Monicka April Koneski |
First Address | Portland, OR 97202-1099 |
Second Address | Portland, OR 97202-1099 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2012 |
Last Update Date | 31/01/2012 |