Provider Demographics
NPI:1215935762
Name:KONAKIS, JANE E (MD)
Entity type:Individual
Prefix:DR
First Name:JANE
Middle Name:E
Last Name:KONAKIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:850 HARVARD WAY
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-2055
Mailing Address - Country:US
Mailing Address - Phone:775-982-5262
Mailing Address - Fax:775-982-5496
Practice Address - Street 1:6570 S MCCARRAN BLVD
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-6112
Practice Address - Country:US
Practice Address - Phone:775-982-8256
Practice Address - Fax:775-982-8251
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2018-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6270207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
11040876OtherCAQH
E91515Medicare UPIN
11040876OtherCAQH