Provider Demographics
NPI:1487195871
Name:KONOPKA, BRETTE (APN)
Entity type:Individual
Prefix:
First Name:BRETTE
Middle Name:
Last Name:KONOPKA
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2271 HIGHWAY 33
Mailing Address - Street 2:STE 103
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08690-1749
Mailing Address - Country:US
Mailing Address - Phone:609-890-4080
Mailing Address - Fax:609-890-4090
Practice Address - Street 1:239 HURFFVILLE CROSSKEYS RD STE 160
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-4005
Practice Address - Country:US
Practice Address - Phone:856-341-8200
Practice Address - Fax:856-341-8215
Is Sole Proprietor?:No
Enumeration Date:2017-03-17
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00716900363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0601543Medicaid