Provider Demographics
NPI:1487938908
Name:KONWISER, AVA (RN)
Entity type:Individual
Prefix:MRS
First Name:AVA
Middle Name:
Last Name:KONWISER
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 1:40 OLIVIA ST
Mailing Address - Street 2:
Mailing Address - City:PORT CHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10573-4802
Mailing Address - Country:US
Mailing Address - Phone:914-934-7988
Mailing Address - Fax:
Practice Address - Street 1:40 OLIVIA ST
Practice Address - Street 2:
Practice Address - City:PORT CHESTER
Practice Address - State:NY
Practice Address - Zip Code:10573-4802
Practice Address - Country:US
Practice Address - Phone:914-934-7988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-03
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY226613163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool