Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician |
NPI | 1194392175 |
---|---|
Provider Name | Ms. Katie Lynn Konken |
First Address | Sterling, CO 80751-2734 |
Second Address | Sterling, CO 80751-2734 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2021 |
Last Update Date | 08/06/2021 |